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Feasibility and Effectiveness of Direct Puncture and Onyx Embolization for Transverse Sinus Dural Arteriovenous Fistula
Yonsei Medical Journal ; : 1112-1115, 2019.
Article in English | WPRIM | ID: wpr-762046
ABSTRACT
Direct puncture and embolization of the transverse sinus (TS) for treatment of dural arteriovenous fistula (DAVF) is typically performed with coils with or without glue. We report a case of DAVF at the left TS that was treated with Onyx embolization via direct puncture of the TS. A 75-year-old woman presented with tremor, festinating gait, and dysarthria. A left TS-DAVF with retrograde superior sagittal sinus and cortical venous reflux (Cognard type IIa+b) was identified on cerebral angiography, and both TSs were occluded with thrombi. We considered that achieving complete cure by transvenous embolization via the femoral vein or transarterial embolization via occipital feeders would be difficult. Thus, we performed a small craniotomy at the occipital bone to puncture the TS. The midportion of the TS was directly punctured with a 21-G microneedle under fluoroscopic guidance. We inserted a 5-F sheath into the TS. A microcatheter was then navigated into the affected sinus. Coils were placed through the microcatheter to support Onyx formation by reducing the pressure of shunting flow. Onyx embolization was performed with the same microcatheter. The DAVF was almost completely occluded except for the presence of minimal shunting flow to the proximal TS. After 1 week, time-of-flight magnetic resonance angiography showed complete resolution of DAVF. The patient showed resolved tremor and markedly improved mental status at 1-month follow up. Direct puncture and embolization of the TS using coils and Onyx is effective and feasible method for the treatment of DAVF when other approaches seem difficult.
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Full text: Available Index: WPRIM (Western Pacific) Main subject: Tremor / Cerebral Angiography / Punctures / Adhesives / Follow-Up Studies / Magnetic Resonance Angiography / Craniotomy / Central Nervous System Vascular Malformations / Gait Disorders, Neurologic / Dysarthria Type of study: Practice guideline / Observational study / Prognostic study Limits: Aged / Female / Humans Language: English Journal: Yonsei Medical Journal Year: 2019 Type: Article

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Full text: Available Index: WPRIM (Western Pacific) Main subject: Tremor / Cerebral Angiography / Punctures / Adhesives / Follow-Up Studies / Magnetic Resonance Angiography / Craniotomy / Central Nervous System Vascular Malformations / Gait Disorders, Neurologic / Dysarthria Type of study: Practice guideline / Observational study / Prognostic study Limits: Aged / Female / Humans Language: English Journal: Yonsei Medical Journal Year: 2019 Type: Article