AJDRAJNR - American Journal of Neuroradiology

Published ahead of print on November 7, 2007
doi: 10.3174/ajnr.A0817
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Endovascular Treatment of Intracranial Dural Arteriovenous Fistulas with Cortical Venous Drainage: New Management Using Onyx

C. Cognard, A.C. Januel, N.A. Silva, Jr and P. Tall

From the Department of Neuroradiology, Hopital Purpan, University of Toulouse, Toulouse, France


Figure 1
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  		Fig 1. A 67-year-old man with a left temporal hematoma. A, Type IV DAVF of the transverse sinus draining directly into the vein of Labbe. B, Middle meningeal artery (MMA) was small compared with the occipital artery. C and D, MMA distal catheterization was easily performed. E, Onyx injection allowed arterio-arterial filling of other arterial feeders and occlusion of the draining vein. F, Postoperative 3-month assessment shows complete fistula cure.


Figure 2
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  		Fig 2. A 62-year-old woman with 1 episode of seizures. A–C, Type IV DAVF of the vein of Galen draining into multiple dilated veins to the superior sagittal sinus. The straight sinus was occluded. D and E, Distal catheterization of the right MMA allowed injection of 11 mL of Onyx in 48 minutes, with retrograde occlusion of other feeders, occlusion of the venous pouch, and no migration into cortical veins. F and G, Postoperative 3-month assessment shows complete fistula cure.


Figure 3
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  		Fig 3. A 68-year-old man with a left cerebellar hematoma. A and B, Type IV DAVF of the tentorium draining into the lateromesencephalic vein, then through a large venous ectasia into the central vein, then to the basal vein and straight sinus. C and D, Injection of Onyx resulted in occlusion of the origin of the draining vein. E, Extensive thrombosis of the draining vein and ectasia due to shunt occlusion with cerebellar rebleeding.


Figure 4
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  		Fig 4. A 68-year-old man with right vision loss. A, Type IV DAVF fed by the distal ophthalmic artery. B, External carotid feeders. C, Distal ophthalmic artery catheterization. D, Injection of 0.8 mL of Onyx over 43 minutes resulted in occlusion of the draining vein origin. E, Postoperative 3-month assessment shows complete fistula cure.


Figure 5
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  		Fig 5. A 67-year-old woman with seizures. A and B, Type IIa+b DAVF of the left transverse sinus draining into cortical veins and in the straight sinus. C and D, Injection of 9.3 mL of Onyx over 90 minutes through the middle meningeal artery. E, Postoperative 7-month assessment shows complete fistula cure.





Copyright © 2009 by the American Society of Neuroradiology. Print ISSN: 0195-6108 Online ISSN: 1936-959X