Christoph Moenninghoff1, Ewelina Pohl2, Cornelius Deuschl2, Karsten Wrede3, Ramazan Jabbarli3, Alexander Radbruch2, Ulrich Sure3, Michael Forsting2, Isabel Wanke4. 1. Institute for diagnostic and interventional Radiology and Neuroradiology, University Hospital Essen, Essen, Germany; Clinic for Neuroradiology, Clemenshospital Muenster, Muenster, Germany. Electronic address: c.moenninghoff@alexianer.de. 2. Institute for diagnostic and interventional Radiology and Neuroradiology, University Hospital Essen, Essen, Germany. 3. Clinic for Neurosurgery, University Hospital Essen, Essen, Germany. 4. Institute for diagnostic and interventional Radiology and Neuroradiology, University Hospital Essen, Essen, Germany; Center for Neuroradiology, Clinic Hirslanden, Zurich, Switzerland.
Abstract
RATIONALE AND OBJECTIVES: This retrospective single-center study aims to evaluate endovascular therapy (EVT) of cranial dural arteriovenous fistulas (dAVF) with ethylene vinyl alcohol (EVOH) copolymer (Onyx) regarding occlusion rates, complications, and recurrences. MATERIAL AND METHODS: From January 2008 to April 2018, 75 patients with dAVF (41 men, 34 women; mean age 56 years) underwent EVT with the nonadhesive liquid embolic agent as primary treatment. Patient records and angiograms were reviewed for demographic data, symptoms, fistula type and size, number of EVTs, amount of embolic material, occlusion rates, and recurrences. RESULTS: Seventy-five patients with dAVFs were primarily embolized with EVOH in 96 EVTs. According to the Merland-Cognard classification the majority of dAVFs treated were type 4 (42.7%), followed by type 2a (18.7%), type 2a+b (17.3%), type 1 (8%), type 2b (5.3%), type 3 (5.3%), and type 5 (2.7%). Complete occlusion (CO) of the dAVF was achieved in 45/75 (60%) of cases after a single EVT and in 58 (77%) patients after one or several EVTs. Seven patients (9%) required additional surgical therapy for CO. Successful treatment was achieved for 70/75 (93%) patients including 10 (13%) patients with residual dAVFs type 1-2a. Recurrence after CO occurred in one (1.3%) patient and four (5.3%) patients remained refractory to therapy with dAVFs type > 2a. Procedure-related permanent morbidity occurred in 4/75 (5.3%) patients. CONCLUSION: For more than a decade transarterial EVOH embolization has established as the first-line treatment for cranial dAVFs with high cure rates and low rates of complications and recurrences. Additional neurosurgical therapy is rarely required for curative treatment.
RATIONALE AND OBJECTIVES: This retrospective single-center study aims to evaluate endovascular therapy (EVT) of cranial dural arteriovenous fistulas (dAVF) with ethylene vinyl alcohol (EVOH) copolymer (Onyx) regarding occlusion rates, complications, and recurrences. MATERIAL AND METHODS: From January 2008 to April 2018, 75 patients with dAVF (41 men, 34 women; mean age 56 years) underwent EVT with the nonadhesive liquid embolic agent as primary treatment. Patient records and angiograms were reviewed for demographic data, symptoms, fistula type and size, number of EVTs, amount of embolic material, occlusion rates, and recurrences. RESULTS: Seventy-five patients with dAVFs were primarily embolized with EVOH in 96 EVTs. According to the Merland-Cognard classification the majority of dAVFs treated were type 4 (42.7%), followed by type 2a (18.7%), type 2a+b (17.3%), type 1 (8%), type 2b (5.3%), type 3 (5.3%), and type 5 (2.7%). Complete occlusion (CO) of the dAVF was achieved in 45/75 (60%) of cases after a single EVT and in 58 (77%) patients after one or several EVTs. Seven patients (9%) required additional surgical therapy for CO. Successful treatment was achieved for 70/75 (93%) patients including 10 (13%) patients with residual dAVFs type 1-2a. Recurrence after CO occurred in one (1.3%) patient and four (5.3%) patients remained refractory to therapy with dAVFs type > 2a. Procedure-related permanent morbidity occurred in 4/75 (5.3%) patients. CONCLUSION: For more than a decade transarterial EVOH embolization has established as the first-line treatment for cranial dAVFs with high cure rates and low rates of complications and recurrences. Additional neurosurgical therapy is rarely required for curative treatment.
Authors: K D Bhatia; H Lee; H Kortman; J Klostranec; W Guest; T Wälchli; I Radovanovic; T Krings; V M Pereira Journal: AJNR Am J Neuroradiol Date: 2021-10-07 Impact factor: 3.825
Authors: K D Bhatia; H Lee; H Kortman; J Klostranec; W Guest; T Wälchli; I Radovanovic; T Krings; V M Pereira Journal: AJNR Am J Neuroradiol Date: 2021-10-14 Impact factor: 3.825
Authors: Mohammed A Azab; Emma R Dioso; Matthew C Findlay; Jayson Nelson; Cameron A Rawanduzy; Philip Johansen; Brandon Lucke-Wold Journal: J Rare Dis Orphan Drugs Date: 2022-06-07
Authors: Marcel Opitz; Sebastian Zensen; Denise Bos; Yan Li; Hanna Styczen; Axel Wetter; Nika Guberina; Ramazan Jabbarli; Ulrich Sure; Michael Forsting; Isabel Wanke; Cornelius Deuschl Journal: Neuroradiology Date: 2021-09-27 Impact factor: 2.804