Fístulas artério-venosas durais intracranianas com drenagem venosa leptomeníngea direta: tratamento endovascular primário com injeção intra-arterial de etilenovinil álcool copolímero a 6% (onyx-18®)

Abstract

Introduction: Dural arteriovenous fistulas (DAVFs) may have aggressive symptoms, especially if there is direct leptomeningeal venous drainage. We report our preliminary experience in transarterial embolization of DAVFs with direct leptomeningeal venous drainage usingethyl vinyl alcohol copolymer(Onyx®).Methods: thirteen patients with DAVFs with direct leptomeningeal venous drainage were treated:eleven type IV and two type III (Cognard). Treatment consisted of transarterial embolization using Onyx-18®. Immediate post treatment angiographies, clinical outcome and 6-month follow-up angiographies were studied.Results: Complete occlusion of the fistula was achieved in all patients with only one procedure and injection in only one arterial pedicle. On follow-up, ten patients became free from symptoms, three improved and no one deteriorated.Follow-up angiographies showed no evidence of recurrent DAVF.Conclusion: We recommend that transarterial Onyx® embolization of DAVFs with direct leptomeningeal venous drainage be considered as a treatment option, while it showed to be feasible, safe and effective.