Percutaneous transvenous packing of cavernous sinus with Onyx for cavernous dural arteriovenous fistula

Objective

The aim of this study is to describe the technique and results of the transvenous approach for occlusion of cavernous dural arteriovenous fistulas (DAVFs) with Onyx.

Methods

Eleven patients presenting with clinically symptomatic DAVFs, were treated between August 2005 and February 2007 at Beijing Tiantan Hospital. We were able to navigate small hydrophilic catheters and microguidwires through the facial vein or inferior petrosal sinus (IPS) into the ipsilateral cavernous sinus. After reaching the fistula site the cavernous sinus was packed with Onyx or combining with detachable platinum coils.

Results

We were able to reach the fistula site and to achieve a good packing of Onyx or combining with coils within the arteriovenous shunting zone in 10 patients. The final angiogram showed complete occlusion of the arteriovenous fistula. Two (18.2%) patients developed a bradycardia during DMSO injection. No complications related to the approach were observed.

Conclusions

Transvenous occlusion of cavernous DAVFs is a feasible approach, even via facial vein or via IPS. Onyx may be another option for cavernous packing other than detachable platinum coils.     

Successful embolization of a renal artery pseudoaneurysm with arteriovenous fistula and extravasations using Onyx after partial nephrectomy for renal cell carcinoma

Partial nephrectomy can be associated with vascular complications. Computed tomography (CT) with CT angiography is ideal for noninvasive imaging of this process. The treatment of choice is selective embolization. Successful transcatheter embolization of right renal subsegmental artery pseudoaneurysm with arteriovenous fistula and extravasations using Onyx was performed in a 66-year-old woman with macrohematuria 12 days after partial nephrectomy for renal cell carcinoma.     

脑动静脉畸形治疗结果对比

目的：通过对39例脑动静脉畸形（AVM）分别进行直接显微外科手术,单纯Onyx胶栓塞治疗的比较研究,探讨治疗AVM的理想方案。方法：按Spetzler--Martin分级随机分为显微外科手术组与血管内栓塞组,疗效的对比是通过对比两组病人术后并发症,术后改良Rankin量表（MRS）及格拉斯哥预后评分（GOS）。结果：①住院期间患者的并发症主要有死亡出血偏瘫失语感染偏盲消化道出血。两组间有显著差异,栓塞组优于外科组;②治疗14d时,患者日常生活能力（MRS量表）及GOS良好率有明显差异,栓塞组优于外科组。治疗90d时,两组间日常生活活动能力（MRS量表）及G0s良好率均无明显差异。结论：对于S-MⅣ级以下的脑AVM,Onyx胶栓塞组术后并发症及短期效果明显优于显微外科组,但中期效果两组无明显差异。     

血管内介入治疗硬脑膜动静脉瘘7例分析

目的 探讨分析血管内介入治疗硬脑膜动静脉瘘的方法与疗效。方法 回顾性分析安徽医科大学第一附属医院神经外科2012年1月至2016年5月收治的7例硬脑膜动静脉瘘（DAVF）患者临床资料，其中经动脉途径栓塞6例，经静脉途径栓塞1例，均应用Onyx胶予以栓塞。结果 7例患者术后即刻造影显示栓塞完全，无死亡病例，无新发神经功能缺失症状，1例海绵窦DAVF患者术后第3天球结膜充血症状完全缓解，所有患者随访3~24个月未出现新发神经功能缺失症状。结论 根据影像学特点，针对不同类型的DAVF选用不同的栓塞途径，血管内栓塞DAVF是微创、安全、有效的治疗方法，可作为DAVF的首选治疗方法。     

10例应用Onyx胶栓塞外伤性颈动脉海绵窦瘘患者的护理

总结10例应用Onyx胶栓塞外伤性颈动脉海绵窦瘘患者的围手术期护理。术前重视心理护理、眼部护理及颈总动脉压迫实验,术中完善准备,严格执行肝素化,术后加强神经系统体征及并发症的观察,指导抗凝药物的规律使用是保证手术后恢复的关键。     

High-grade dural arteriovenous fistula simulating a bilateral thalamic neoplasm

Dural arteriovenous fistulae (dAVF) provide a diagnostic challenge and must be part of a broad differential in pursuit of a difficult diagnosis or unusual presentation. This case report demonstrates an initially misguided diagnosis of bilateral thalamic neoplasm and demonstrates the importance of continued pursuit until the correct diagnosis is obtained. Moreover, to our knowledge, this is the first reported case of a dAVF simulating a bilateral thalamic neoplasm. We present a patient with a provisional diagnosis of bilateral thalamic neoplasm based on clinical history and an advanced imaging workup including MR spectroscopy. Subsequent biopsy suggested venous congestion, hypoxia, and edema without neoplasia. Routine post-operative CT the following day revealed suggestion of dAVF due to the presence of residual contrast from prior unrelated abdominal CT. Cerebral angiography eventually revealed a Cognard grade IIb dAVF. Trans-arterial Onyx embolization resulted in a dramatic clinical and radiographic improvement. This case highlights an unusual presentation and challenging diagnosis of a dAVF and the importance of pursuing the correct diagnosis.     

Onyx胶治疗脑动静脉畸形相关动脉瘤二例及文献复习

目的 探讨Onyx胶治疗动静脉畸形(AVM)相关的供血动脉蒂动脉瘤中的应用价值.方法 结合文献复习,回顾性分析2例大脑后动脉远端AVM相关的大型供血动脉蒂动脉瘤病例资料.结果 根据病变血管构筑特征及临床特点,对1例病人采用Onyx胶结合弹簧圈的方法进行栓塞,而对另1例病人则采用单纯利用Onyx胶进行栓塞.结果 提示Onyx胶结合弹簧圈的方法能降低术中动脉瘤破裂的风险,并能达到致密栓塞.结论 Onyx胶结合弹簧圈的方法有助于治疗动静脉畸形(AVM)相关的大型供血动脉蒂动脉瘤.     

Onyx液态栓塞剂治疗高级别脑动静脉畸形的临床体会

目的 探讨高级别(Spetzler-Martin Ⅳ～Ⅴ级)脑动静脉畸形(AVMs)治疗中Onyx液态栓塞剂的方法和作用.方法 回顾性分析32例高级别AVMs运用Onyx治疗的临床资料,并对高级别AVMs的手术适应证以及手术方法的选择加以讨论.结果 运用Onyx液态栓塞剂治疗26例高级别AVMs,经过血管内栓塞治疗后完全栓塞13例,大部栓塞10例,不全栓塞3例.其中10例经过手术和(或)放射治疗,随访期间,全脑血管造影检查提示动静脉闭塞23例;26例患者恢复良好,术后出血2例,未见新的神经功能损害出现,无死亡病例.结论 对于高级别AVMs,首选用Onyx液态栓塞剂治疗,采用微导管超选到位、控制性注射以及对静脉的保护,可以改善高级别AVMs的疗效.