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Feasibility and Effectiveness of Direct Puncture and Onyx Embolization for Transverse Sinus Dural Arteriovenous Fistula.
Yonsei Med J 2019; 60(11):1112-1115YM

Abstract

Direct puncture and embolization of the transverse sinus (TS) for treatment of dural arteriovenous fistula (DAVF) is typically performed with coils with or without glue. We report a case of DAVF at the left TS that was treated with Onyx embolization via direct puncture of the TS. A 75-year-old woman presented with tremor, festinating gait, and dysarthria. A left TS-DAVF with retrograde superior sagittal sinus and cortical venous reflux (Cognard type IIa+b) was identified on cerebral angiography, and both TSs were occluded with thrombi. We considered that achieving complete cure by transvenous embolization via the femoral vein or transarterial embolization via occipital feeders would be difficult. Thus, we performed a small craniotomy at the occipital bone to puncture the TS. The midportion of the TS was directly punctured with a 21-G microneedle under fluoroscopic guidance. We inserted a 5-F sheath into the TS. A microcatheter was then navigated into the affected sinus. Coils were placed through the microcatheter to support Onyx formation by reducing the pressure of shunting flow. Onyx embolization was performed with the same microcatheter. The DAVF was almost completely occluded except for the presence of minimal shunting flow to the proximal TS. After 1 week, time-of-flight magnetic resonance angiography showed complete resolution of DAVF. The patient showed resolved tremor and markedly improved mental status at 1-month follow up. Direct puncture and embolization of the TS using coils and Onyx is effective and feasible method for the treatment of DAVF when other approaches seem difficult.

Authors+Show Affiliations

Department of Neurosurgery, Chung-Ang University Hospital, Chung-Ang University College of Medicine, Seoul, Korea.Department of Radiology, Chung-Ang University Hospital, Chung-Ang University College of Medicine, Seoul, Korea. flightdr61@hanmail.net.Department of Neurosurgery, Chung-Ang University Hospital, Chung-Ang University College of Medicine, Seoul, Korea. Department of Neurosurgery, Kangwon National University School of Medicine, Chuncheon, Korea.Department of Radiology, Chung-Ang University Hospital, Chung-Ang University College of Medicine, Seoul, Korea.Department of Radiology, Chung-Ang University Hospital, Chung-Ang University College of Medicine, Seoul, Korea.

Pub Type(s)

Case Reports

Language

eng

PubMed ID

31637895

Citation

Nam, Taek Kyun, et al. "Feasibility and Effectiveness of Direct Puncture and Onyx Embolization for Transverse Sinus Dural Arteriovenous Fistula." Yonsei Medical Journal, vol. 60, no. 11, 2019, pp. 1112-1115.
Nam TK, Byun JS, Choi HH, et al. Feasibility and Effectiveness of Direct Puncture and Onyx Embolization for Transverse Sinus Dural Arteriovenous Fistula. Yonsei Med J. 2019;60(11):1112-1115.
Nam, T. K., Byun, J. S., Choi, H. H., Chung, M. S., & Lee, E. J. (2019). Feasibility and Effectiveness of Direct Puncture and Onyx Embolization for Transverse Sinus Dural Arteriovenous Fistula. Yonsei Medical Journal, 60(11), pp. 1112-1115. doi:10.3349/ymj.2019.60.11.1112.
Nam TK, et al. Feasibility and Effectiveness of Direct Puncture and Onyx Embolization for Transverse Sinus Dural Arteriovenous Fistula. Yonsei Med J. 2019;60(11):1112-1115. PubMed PMID: 31637895.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Feasibility and Effectiveness of Direct Puncture and Onyx Embolization for Transverse Sinus Dural Arteriovenous Fistula. AU - Nam,Taek Kyun, AU - Byun,Jun Soo, AU - Choi,Hyun Ho, AU - Chung,Mi Sun, AU - Lee,Eun Jung, PY - 2019/07/03/received PY - 2019/08/09/revised PY - 2019/08/21/accepted PY - 2019/10/23/entrez PY - 2019/10/23/pubmed PY - 2019/10/23/medline KW - Dural arteriovenous fistula KW - Onyx KW - coil KW - embolization KW - transcranial SP - 1112 EP - 1115 JF - Yonsei medical journal JO - Yonsei Med. J. VL - 60 IS - 11 N2 - Direct puncture and embolization of the transverse sinus (TS) for treatment of dural arteriovenous fistula (DAVF) is typically performed with coils with or without glue. We report a case of DAVF at the left TS that was treated with Onyx embolization via direct puncture of the TS. A 75-year-old woman presented with tremor, festinating gait, and dysarthria. A left TS-DAVF with retrograde superior sagittal sinus and cortical venous reflux (Cognard type IIa+b) was identified on cerebral angiography, and both TSs were occluded with thrombi. We considered that achieving complete cure by transvenous embolization via the femoral vein or transarterial embolization via occipital feeders would be difficult. Thus, we performed a small craniotomy at the occipital bone to puncture the TS. The midportion of the TS was directly punctured with a 21-G microneedle under fluoroscopic guidance. We inserted a 5-F sheath into the TS. A microcatheter was then navigated into the affected sinus. Coils were placed through the microcatheter to support Onyx formation by reducing the pressure of shunting flow. Onyx embolization was performed with the same microcatheter. The DAVF was almost completely occluded except for the presence of minimal shunting flow to the proximal TS. After 1 week, time-of-flight magnetic resonance angiography showed complete resolution of DAVF. The patient showed resolved tremor and markedly improved mental status at 1-month follow up. Direct puncture and embolization of the TS using coils and Onyx is effective and feasible method for the treatment of DAVF when other approaches seem difficult. SN - 1976-2437 UR - https://www.unboundmedicine.com/medline/citation/31637895/Feasibility_and_Effectiveness_of_Direct_Puncture_and_Onyx_Embolization_for_Transverse_Sinus_Dural_Arteriovenous_Fistula L2 - https://www.eymj.org/DOIx.php?id=10.3349/ymj.2019.60.11.1112 DB - PRIME DP - Unbound Medicine ER -