Embolization of dural arteriovenous fistula via unopacified venous sinus

Objective: To explore the feasibility, safety and efficacy of embolization of dural arteriovenous fistulas (DAVF) via unopacified venous sinus. Methods: Ninety two patients with DAVF treated by embolization via unopacified venous sinus were selected. The lesions of 91 patients were in the cavernous sinus areas, and the lesion of one patient was in the lateral sinus area. DAVFs in the cavernous sinus areas were embolized by probing the unopacified inferior petrous sinuses via the initial segment of internal jugular veins entering into the draining venous sinuses; DAVFs in lateral sinus areas were embolized by probing the unopacified sigmoid sinuses via internal jugular veins entering into the venous sinuses. The first choice of embolization was the detachable fibered coils. After blood flow slowdown, the free fibered coils were used to embolize continuously. If a few fistulas still existed at the end of embolization, Glubran(25% -33%) or Onyx18 could be injected into venous sinuses. The success rate of catheterization, safety, and efficacy of embolization were observed. The patients were followed up for 6 months by telephone, clinical consultation and DSA examination. Results: Among the 92 patients, no complication or death occurred. Catheterization was failed in one patient with DAVF in cavernous sinus area; the catheterization was smooth in the other 91 patients, and their venous embolization was successful. No abnormal venous sinus displayed in immediate angiography after the embolization in all patients, and their fistulas disappeared, which achieved cure on imaging. Both the successful rate of catheterization and the cure rate were 99% (91/92). Thirty-eight patients were followed up by DSA, and the others were followed up by telephone or clinical consultation. The follow-up period was 6 to 12 months. There was no recurrence among the 38 patients who were followed up by DSA for 6 months. The clinical symptoms in all patients were improved or resolved. Conclusion: The embolization of DAVF via unopacified venous sinus is a safe and effective method, especially for DAVF in cavernous sinus area. Superselective catheterization for embolization via unopacified inferior petrous sinus has higher feasibility, safety and efficacy. It can be used as a first - choice therapy for the conventional treatment of DAVFs in cavernous sinus areas.