Onyx transarterial embolization of dural arteriovenous fistula for failed N-butyl cyanoacrylate treatment: case report

Objective: To report efficacy of transarterial Onyx embolization of dural arteriovenous fistulas (DAVFs) previously treated with N-butyl cyanoacrylate (NBCA). Two cases are presented with special considerations given to the technical and anatomical aspects based on operative findings. Case Presentation: Superior petrosal and tentorial DAVFs presented with tinnitus and cortical venous reflux, headache with decreased cognitive function respectively. The DAVFs were initially treated with multiple injections of NBCA ending in persistently remaining fistula, subsequently leading to recurrence. Transarterial Onyx embolization was performed, resulting in penetration of Onyx into the complex vascular network and draining veins, with retrograde filling of multiple feeding arteries. The affected sinus was preserved. Conclusion: With the potential of better penetration of Onyx, transarterial Onyx embolization may be capable of treating recurrent NBCA-treated DAVFs. Larger number of cases and longer follow-up are required to determine the efficacy and safety of transarterial Onyx embolization of DAVFs.