The Yakes Vascular Malformation Center, United States
Purpose: To evaluate the efficacy of ethanol, ethanol and coils, nBCA, and Onyx management of complex dural AVF.
Material and Methods: 13 patients (mean age 39 years; 8 females, 5 males). All patients presented with dural AVF involving the transverse sinus, sigmoid sinus and cavernous sinus. 1 patient suffered from high output cardiac state due to the massive size of her combined dural fistula and scalp AVM. All patients underwent MR and cerebral arteriogram evaluations. Patients underwent ethanol embolization, coil embolization, ethanol and coil embolization, nBCA embolization and Onyx embolization to treat these acquired dural AVF.
Results: 12 of 13 patients were endovascularly cured of their disease at a mean follow-up of 5 months. 1 patient’s therapy is on going. In those patients who had thrombosed sigmoid sinuses and partially thrombosed transverse sinuses with venous drainage being cortical because of the occluded sinuses, novel approaches were utilized to reach the point of fistualization and treat with coils and ethanol. Sacrifice of the diseased transverse and sigmoid sinus was also utilized to treat the large dural AVF involving these segments. In the cavernous sinus coil embolization and nBCA embolization was utilized via surgical cut-down to access the Superior Ophthalmic Vein to navigate to the Cavernous Sinus when the Inferior Petrosal Sinus was incomplete. In those patients presenting with pulsatile tinnitus it was absent at follow-up. Headaches also resolved. Except for one patient with a transient homonymous hemianopsia, no other complications occurred.
Conclusions: Complex acquired dural AVF can be treated and cured by endovascular means. With meticulous technique complications can be avoided. Many embolic agents are successful in ablating dural AVF in all dural sinuses; ethanol, coils, Onyx.