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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
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.
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.
