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AJNR - American Journal of Neuroradiology

Published ahead of print on November 1, 2007
doi: 10.3174/ajnr.A0768

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Preliminary Experience with Onyx Embolization for the Treatment of Intracranial Dural Arteriovenous Fistulas

R.G. Nogueira^a,b, G. Dabus^a, J.D. Rabinov^a, C.J. Eskey^a, C.S. Ogilvy^c, J.A. Hirsch^a and J.C. Pryor^a

^a Division of Interventional Neuroradiology and Endovascular Neurosurgery, Massachusetts General Hospital, Boston, Mass
^b Division of Vascular and Critical Care Neurology, Massachusetts General Hospital, Boston, Mass
^c Division of Vascular Neurosurgery, Massachusetts General Hospital, Boston, Mass

View larger version (150K): [in this window] [in a new window]   Fig 1. A, Left common carotid angiography (lateral view). B, Left vertebral angiography (anteroposterior view). C, Postembolization left common carotid angiography (lateral view). The black arrow points to the subtracted Onyx cast. D, Postembolization left vertebral angiography (AP view, native image). The double white arrow points to the Onyx cast. The single white arrow points to Onyx reflux into the distal vertebral dural branch.

View larger version (137K): [in this window] [in a new window]   Fig 2. A, Simultaneous bilateral external carotid angiography (AP view). B, Left external carotid angiography (lateral view). C, Right external carotid angiography 4.6 months after stage II embolization. Right upper corner shows microcatheter angiography before stage III Onyx embolization (arrowhead, microcatheter tip; arrow, previous Onyx cast; circle, final target). D, Left common carotid angiography 4.6 months after stage II embolization (lateral view). E–F, Poststage III embolization right (E, AP view late venous phase) and left (F, lateral view arterial phase) common carotid angiography show complete resolution of the fistula with preservation of the venous sinuses and obliteration of the left PCA (F, double white arrow), middle meningeal (F, black arrowhead), and occipital supply (F, black arrow). E, double white arrow, Subtracted Onyx cast; E, black arrowhead, Onyx in the transverse sinus leaflet. G and H, (AP view-native images) Onyx cast before (G) and after (H) the third and final embolization. Note that the target area showed on G has been completely filled with the embolic agent on H (white circle).

View larger version (158K): [in this window] [in a new window]   Fig 3. A, Right external carotid angiography (lateral view). B, Right middle menigeal microcatether angiography (lateral view). C, Native image demonstrating a dense Onyx cast in the right middle meningeal artery (black arrow) extending into the fistula (arrowheads). D, Postembolization right common carotid angiography (lateral view-late venous phase).

View larger version (149K): [in this window] [in a new window]   Fig 4. A, Right external carotid angiography (lateral view). B, Left external carotid angiography (AP view). C, Left internal carotid angiography (lateral view). D, Left vertebral artery angiography (lateral view). E, Postembolization right common carotid angiography (lateral view). F, Postembolization left common carotid angiography (lateral view). G, Postembolization left vertebral angiography (lateral view). H, Postembolization native image, Onyx cast (AP view).

View larger version (116K): [in this window] [in a new window]   Fig 5. A, Left common carotid angiography (lateral view). B, Left vertebral angiography (lateral view). C, Postembolization left common carotid angiography (lateral view). D, Postembolization left vertebral angiography (lateral view).