Introduction: Dural Arteriovenous Fistulas (dAVFs) are abnormal vascular channels formed between venous sinuses or cortical veins and dural arteries, with idiopathic or multi-factorial causations, varied clinical presentations, and complex radiological angioarchitecture. However, intra-arterial embolisation is the preferred management. Aim: To study the clinical presentation and short-term outcomes of endovascular onyx embolisation for dAVFs. Materials and Methods: The present prospective observational study was conducted at a tertiary care centre in Maharashtra, India from September 2016 to August 2017. Adults presented to an Emergency department with the symptoms of headache, convulsions, vomiting, or stroke and subsequently underwent Digital Subtraction Angiography (DSA) were screened. Patients diagnosed with dAVFs and treated with endovascular embolisation under general anaesthesia via the transfemoral route using a liquid embolic agent (onyx) were studied. Clinical presentation and angio architecture of dAVF have been reported along with the post embolisation complications. Results: A total of 10 (8 males) patients were studied. Patients had an age range of 21-45 years. Convulsions 5 (50%) neurodeficit, and headache 4 (40%) each) were the most common presenting complaints. Left transverse sinus was the prominent dAVF location observed 4 (33.33%). A total of 12 arteries were embolised, (10 (83.33%) arteries showed no angiographic residue after a single session of embolisation, and 2 (16.67%) patients had minimal residue after two sessions of trans-arterial onyx embolisation). Conclusion: Endovascular onyx embolisation should be the treatment of choice for dAVFs. Onyx in appropriate concentration and a finely-honed technique achieves better cure rates.
Arkar et al. (Sat,) studied this question.