Use of onyx in the management of tentorial dural arteriovenous fistulae.

Abstract

Tentorial dural arteriovenous fistula (DAVF) is an uncommon disease with a poor natural history. Management of tentorial DAVF remains controversial. This study reports the technique and results of transarterial embolization using Onyx (Micro Therapeutics Inc., Irvine, CA) in the treatment of a series of 14 patients with tentorial DAVFs. We retrospectively reviewed the clinical and radiological data of 14 patients with tentorial DAVFs who were treated by transarterial embolization using Onyx at Shanghai Changhai Hospital between 2005 and 2008. Twelve patients presented with subarachnoid or intraventricular hemorrhage. Complete cure was achieved in 11 patients after 1 procedure and in 1 patient after 2 procedures. Incomplete cure was obtained in the other 2 patients. One patient experienced vessel perforation; another had microcatheter retention. All of the patients recovered well, except 1 patient who died of severe infection caused by ventricular drainage. Clinical follow-up showed no rebleeding or worsening. Follow-up angiography in 8 patients with total occlusion demonstrated no recurrence. These results suggest that transarterial embolization using Onyx is feasible and effective for the management of tentorial DAVFs.