Neurointervention.  2013 Sep;8(2):110-114. 10.5469/neuroint.2013.8.2.110.

Onyx Embolization of Dural Arteriovenous Fistula, using Scepter C Balloon Catheter: a Case Report

• Kim ST
• Jeong HW
• Seo J

• KMID: 1784028
• DOI: http://doi.org/10.5469/neuroint.2013.8.2.110

Abstract

We report our experience using Onyx for embolization of dural arteriovenous fistula (DAVF) under dual lumen balloon catheter flow arrest. Transfemoral cerebral angiography revealed a superior sagittal sinus (SSS) DAVF that was supplied via multiple branches of the external carotid arteries, the right anterior cerebral arteries, and the meningeal branches of the internal carotid artery. There was no anterograde venous drainage through the SSS, and venous drainage was almost retrograde through the medullary and cortical veins. Under general anesthesia, a transvenous approach was utilized to place the microcatheter close to the fistula site. After intravenous embolization with various coils, DAVF was partially occluded; Balloon catheter gained access to the DAVF via the right middle meningeal artery. We injected Onyx through the Scepter C catheter, after which DAVF was nearly completely occluded. Balloon-assisted Onyx embolization is a feasible and effective approach for the management of DAVF.

Keyword

Dural arteriovenous fistula; Balloon; Embolization; Onyx

MeSH Terms

Anesthesia, General
Anterior Cerebral Artery
Carotid Artery, External
Carotid Artery, Internal
Catheters
Central Nervous System Vascular Malformations
Cerebral Angiography
Drainage
Fistula
Hypogonadism
Meningeal Arteries
Mitochondrial Diseases
Ophthalmoplegia
Superior Sagittal Sinus
Veins
Hypogonadism
Mitochondrial Diseases
Ophthalmoplegia

Figure

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  Fig. 1 A. Brain atrophy and venous congestion was observed by MRI.B. Transfemoral cerebral angiography showed the SSS DAVF was supplied via multiple branches of the external carotid artery (ECA), the right anterior cerebral arteries, and the meningeal branches of the internal carotid artery (ICA) and vertebral artery.C. Drainage through the SSS was not observed, while drainage through the vein of Labbe and sphenoparietal sinus was main (not shown). Transfemoral cerebral angiography (TFCA) revealed venous hypertension and galenic venous drainage. Furthermore, TFCA showed CVR (The hallow indicates CVR).D. Using the transvenous approach, a microcatheter (Echelon 10) was placed at the fistulous sac of the SSS.E. After intravenous coil embolization using various coils, retrograde drainage through the fistula remained (arrow).F. Scepter C balloon catheter (4×15 mm) was placed at the most distal segment of the middle meningeal artery. Tip of the balloon microcatheter was positioned at DAVF, and balloon was successfully performed (arrow).G. Over a period of 22 minutes, a total of 4.5 cc of Onyx18 was injected, and DAVF was almost completely occluded.H. After embolization, angiography revealed that no arteriovenous shunting and no cortical venous reflux occurred. Right ECA angiography.

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