Dural arteriovenous fistula onyx embolization through a non-visible previously embolized pedicle.

Abstract

Cerebral dural arteriovenous fistulas (dAVFs) are commonly treated with endovascular embolization, either through arterial or venous routes in single or multi-staged procedures. Treatment outcomes depend on multiple factors, including the patient's clinical status, the anatomy of the malformation, and the operator's experience, but technical success is also highly dependent on choice of neurovascular devices and embolic agents. When transvenous routes are not feasible and the most obvious transarterial routes do not appear safe, deep knowledge of the dynamic fluid properties of liquid embolics can be a valuable asset. We present a case(video 1) in which a complex skull-base dAVF was completely occluded through a non-visualized previously partially embolized arterial feeder. It is a unique case in which the embolization takes advantage of the peculiar fluid dynamic properties of non-adhesive embolic agents (Onyx-Medtronic, Minnesota, USA) 18 and 34.1-3 neurintsurg;16/8/852/V1F1V1Video 1 Technical video presenting a dAVF completely cured through a non-visible previously embolized arterial pedicle.