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ORIGINAL RESEARCH article

Front. Neurol.
Sec. Endovascular and Interventional Neurology
Volume 15 - 2024 | doi: 10.3389/fneur.2024.1416945
This article is part of the Research Topic Neuroanatomical Considerations and Advances in Approaches for Cerebral Arteriovenous Malformations View all articles

Grouting Technique -Combining Transvenous Onyx and Coils for the Embolization of Complex Non-cavernous Intracranial Dural Arteriovenous Fistulas

Provisionally accepted
Ching-Chang Chen Ching-Chang Chen *Chun-Ting Chen Chun-Ting Chen Yi-Ming Wu Yi-Ming Wu Mun-Chun Yeap Mun-Chun Yeap Yao-Liang Chen Yao-Liang Chen Ho-Fai Wong Ho-Fai Wong
  • Linkou Chang Gung Memorial Hospital, Linkou, Taiwan

The final, formatted version of the article will be published soon.

    Abstract Objective: Incomplete occlusion of cerebral dural arteriovenous fistula (DAVF) may lead to fistula recurrence and rebleeding, which may necessitate several embolizations and lead to worse clinical outcomes. Herein, we describe a grouting technique for endovascular embolization and its outcomes in a series of patients with complex intracranial DAVF. Methods: A total of 20 patients with aggressive type or symptomatic intracranial non-cavernous DAVF underwent endovascular transvenous embolization combining detachable coils and Onyx. Two microcatheters were positioned either in the distal segment of the involved sinus or near the draining veins. To achieve tight occlusion of the involved sinus, coils were carefully delivered through the first microcatheter, starting from the distal segment and then to the proximal segment. Next, Onyx was injected through the second microcatheter to reinforce and fill (grout) the interspace of coil mass and gradually refluxed to the mural channels and para-sinus cortical veins until the fistula was completely occluded. Results: Successful embolization was achieved in all 20 patients. The initial angiographic results revealed the achievement of complete occlusion in 19 patients (95%). At the postembolization follow-up, complete obliteration of the fistula was achieved in all patients (100%). No symptom or angiographic recurrence was observed at the 2- to 5-year follow-ups. No patient required additional embolization or stereotactic radiosurgery. Conclusion: The proposed grouting technique combining detachable coils and Onyx appears to be promising for the elimination of complex intracranial non-cavernous DAVFs.

    Keywords: dural arteriovenous fistula, Endovascular, Transvenous approach, Coil embolization, Onyx

    Received: 13 Apr 2024; Accepted: 12 Jul 2024.

    Copyright: © 2024 Chen, Chen, Wu, Yeap, Chen and Wong. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.

    * Correspondence: Ching-Chang Chen, Linkou Chang Gung Memorial Hospital, Linkou, Taiwan

    Disclaimer: All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article or claim that may be made by its manufacturer is not guaranteed or endorsed by the publisher.