American Association of Neurological Surgeons | Staged transarterial endovascular embolization of malignant dAVF using Onyx & n-butyl cyanoacrylate @AANSNeurosurgery | Uploaded October 2019 | Updated October 2024, 6 hours ago.
Silvia Gesheva, MD, William T. Couldwell, MD, PhD, Vance Mortimer, Philipp Taussky, MD, and Ramesh Grandhi, MD

Department of Neurological Surgery, Clinical Neurosciences Center, University of Utah, Salt Lake City, Utah

Dural arteriovenous fistulae (dAVFs) are vascular anomalies formed by abnormal connections between branches of dural arteries and dural veins or dural venous sinus(es). These pathologic shunts constitute 10%–15% of all intracranial arteriovenous malformations. The hallmark of malignant dAVFs is the presence of cortical venous drainage, a finding that increases the likelihood of nonhemorrhagic neurologic deficit, intracranial hemorrhage, and mortality if left unaddressed. Endovascular approaches have become the primary modality for the treatment of dAVFs. The authors present a case of staged endovascular transarterial embolization of a malignant dAVF running parallel to the left transverse sinus in a patient with headaches and pulsatile tinnitus. The fistula was completely treated using Onyx and n-butyl cyanoacrylate.