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[Failure of transverse sinus dural fistula embolization using ethanol injection]
C Barbier1, M Legeais, J-P Cottier
1Service de neuroradiologie, hôpital Bretonneau, CHRU de Tours, 2, boulevard Tonnellé, 37044 Tours cedex 1, France.
Summary
Absolute alcohol embolization for dural fistulas showed temporary success, necessitating further treatment. This case report highlights the unreliability of absolute alcohol for intracranial dural arteriovenous fistulas.
Area of Science:
- Neurology
- Interventional Radiology
- Vascular Surgery
Background:
- Dural arteriovenous fistulas (dAVFs) are abnormal connections between dural arteries and veins.
- Treatment options for dAVFs include surgical, endovascular, or radiosurgical approaches.
Observation:
- A two-part embolization of a left sagittal sinus dural fistula was performed.
- The initial embolization used n-butyl-cyanoacrylate (n-BCA) via the external carotid artery.
- A subsequent embolization with 1 ml of 95% ethanol targeted the internal carotid artery supply.
Findings:
- The n-BCA embolization successfully excluded arterial supply from the medial meningeal and occipital arteries.
- Ethanol embolization occluded the tentorium marginalis artery but resulted in a reversible cranial nerve III palsy.
- While initially satisfactory, a one-year follow-up revealed fistula revascularization, ultimately treated successfully with Onyx.
Implications:
- Intracranial use of absolute alcohol for dural fistulas appears unreliable, offering only temporary occlusion.
- Alternative agents like n-BCA and Onyx may provide more durable results for dural arteriovenous fistulas.
- Careful consideration of embolic agents and potential complications is crucial in managing complex dAVFs.
