A Case of Curative Onyx Embolization for Tentorial dAVF via Low-flow Feeders with Temporary Balloon Occlusion of High-flow Feeders

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  • Ogura Ryosuke
    Department of Neurosurgery, Brain Research Institute, University of Niigata, Niigata, Niigata, Japan Department of Neurosurgery, Nagano Red Cross Hospital, Nagano, Nagano, Japan
  • Hasegawa Hitoshi
    Department of Neurosurgery, Brain Research Institute, University of Niigata, Niigata, Niigata, Japan
  • Kumagai Shunsuke
    Department of Neurosurgery, Nagano Red Cross Hospital, Nagano, Nagano, Japan
  • Takahashi Haruhiko
    Department of Neurosurgery, Brain Research Institute, University of Niigata, Niigata, Niigata, Japan Department of Neurosurgery, Nagano Red Cross Hospital, Nagano, Nagano, Japan
  • Fujiwara Hidemoto
    Department of Neurosurgery, Nagano Red Cross Hospital, Nagano, Nagano, Japan
  • Yoshimura Junichi
    Department of Neurosurgery, Brain Research Institute, University of Niigata, Niigata, Niigata, Japan Department of Neurosurgery, Nagano Red Cross Hospital, Nagano, Nagano, Japan
  • Fujii Yukihiko
    Department of Neurosurgery, Brain Research Institute, University of Niigata, Niigata, Niigata, Japan

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<p>Objective: For curative Onyx embolization of dural arteriovenous fistulas (dAVF) with multiple feeders, it is essential to select the optimal target artery as well as to control the blood flow at the fistula point. We report a case of tentorial dAVF (TdAVF) treated by Onyx embolization under flow control using balloon catheters.</p><p>Case Presentation: A 66-year-old male was admitted to our hospital for treatment of TdAVF detected incidentally by MRI, which revealed a dilated and tortuous vein around the cerebellum. Cerebral angiography demonstrated a TdAVF, fed mainly by bilateral middle meningeal arteries (MMA) and bilateral occipital arteries (OA), with the fistula point at the torcular and venous drainage to the two superior vermian veins (SVVs). Onyx 18 was injected from the low-flow feeder of the MMA under flow control by occluding the high-flow feeder of the OA using balloon catheters, obliterating the arteriovenous shunt.</p><p>Conclusion: In treatment of TdAVF involving low- and high-flow feeders, Onyx embolization via the low-flow feeder with temporary balloon occlusion of other high-flow feeders is a useful method. This technique makes it easier for Onyx to penetrate the fistula point.</p>

収録刊行物

  • 脳神経血管内治療

    脳神経血管内治療 14 (3), 112-117, 2020

    特定非営利活動法人 日本脳神経血管内治療学会

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