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Related Experiment Video

Updated: Jul 25, 2025

Comprehensive Endovascular and Open Surgical Management of Cerebral Arteriovenous Malformations
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Torcular dural AVF: Transvenous onyx embolisation with sinus reconstruction.

Vipul Gupta1, Rajsrinivas Parthasarathy1, Dhaval Thakkar2

  • 1Department of Stroke & Neurointervention, Artemis Agrim Institute of Neurosciences, India.

Clinical Neurology and Neurosurgery
|June 23, 2023
PubMed
Summary

Transvenous embolization using Onyx and a venous balloon is a new technique for treating dural arteriovenous fistulas, successfully preserving the sinus in a complex torcular case. This method offers a viable treatment for complex dural AV fistulas.

Keywords:
Basilar arteryIntracranial atherosclerotic diseaseSelf-expanding stent

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Area of Science:

  • Interventional Neuroradiology
  • Vascular Neurology
  • Neurosurgery

Background:

  • Dural arteriovenous fistulas (dAVFs) pose significant treatment challenges, particularly those involving critical venous structures like the torcula.
  • Traditional embolization techniques may risk sinus or cortical vein injury.

Discussion:

  • Transvenous embolization with sinus reconstruction using a venous balloon offers a novel approach to occlude dAVFs while maintaining sinus patency.
  • This technique requires meticulous pre-procedural angioarchitecture analysis and precise balloon placement for successful retrograde Onyx delivery.
  • Managing retrograde flow into the superior sagittal sinus and cortical veins is crucial for preventing complications.

Key Insights:

  • Successful embolization of a type 2c torcular dAVF was achieved using transvenous Onyx delivery with sinus reconstruction.
  • Venous balloon inflation guided retrograde Onyx permeation into arterial feeders, ensuring complete fistula occlusion.
  • Preservation of the torcular sinus and cortical veins was achieved, preventing neurological deficits.

Outlook:

  • This technique holds promise for treating complex dAVFs involving vital venous sinuses.
  • Further studies are warranted to evaluate the long-term efficacy and safety of this sinus-preserving embolization strategy.
  • Refinement of microcatheter navigation and balloon techniques can optimize outcomes for dAVF treatment.