Onyx as an adjunctive embolic material for transvenous embolization of cavernous sinus dural arteriovenous fistula after coiling

Q: What problem does this study address regarding TVCE for CSDAVFs?

Even though TVCE is effective, some patients have residual fistulas or worsening visual symptoms after the procedure. The study evaluates adding Onyx after coiling to address these issues.

Q: How many patients and fistulas were included, and what follow-up duration was used?

The study included 207 patients with 222 CSDAVFs, with complete angiographic follow-up over 9 years. Ninety patients with 97 CSDAVFs underwent TVCOE after coiling.

Q: What were the main reasons clinicians selected TVCOE and what outcomes were compared?

Key reasons included better immediate complete obliteration, presence of cranial nerve palsy, residual fistula with persistent pial venous reflux, and redirection of fistula flow. The paper compares clinical and angiographic outcomes between TVCOE and TVCE.

Sep 29, 2026

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Background: Transvenous coil embolization (TVCE) is an effective treatment for cavernous sinus dural arteriovenous fistulas (CSDAVFs), but residual fistulas or worsening visual symptoms can occur. Methods: This retrospective study compared TVCE with transvenous coil and Onyx embolization (TVCOE) in 207 patients with 222 CSDAVFs over 9 years. Results: TVCOE was selected to improve immediate obliteration, address cranial nerve palsy, and manage residual pial venous reflux. Conclusion: Small-volume Onyx as an adjunct reduced coil use and improved immediate complete obliteration, with no significant differences in major complications or angiographic follow-up outcomes.

LanguageEnglish

CategoryHealthcare

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J Chin MedAssoc Original article Onyx as an adjunctive embolic material for transvenous embolization of cavernous sinus dural arteriovenous fistula after coiling Chao-Bao Luoa,b,c, Chien-Hui Leea,*, Hsiang-Yun Lob, Feng-Chi Changb, Chung-Jung Linb aDepartment of Neurosurgery, Buddhist Tzu-Chi General Hospital and Tzu-Chi University, Hualien, Taiwan, ROC; bDepartment of Radiology, Taipei Veterans General Hospital and National Yang Ming Chiao Tung University School of Medicine, Taipei, Taiwan, ROC; cDepartment of Radiology, Tri-Service General Hospital and National Defenses Medical Center, Taipei, Taiwan, ROC Abstract Background: Transvenous coil embolization (TVCE) is a common and effective treatment for cavernous sinus dural arteriovenous fistulas (CSDAVFs) . However, some patients may experience residual fistulas or worsening visual symptoms after the procedure. This study aimed to compare the effectiveness of transvenous coil and Onyx embolization (TVCOE) with TVCE in treating CSDAVFs. Methods: The study included 207 patients with 222 CSDAVFs referred for TVCE, all of whom had complete angiographic followup over 9 years. Ninety patients (mean age, 65.3 years) with 97 CSDAVFs underwent TVCOE after coiling. Clinical data, angioarchitecture, and outcomes were retrospectively assessed and compared to 125 CSDAVFs treated with TVCE. Results: Key reasons for selecting TVCOE included improvement in immediate complete obliteration of CSDAVFs (n = 47, 48.5%), presence of cranial nerve palsy (n = 26, 26.8%), residual fistula with persistent pial venous reflux (n = 22, 22.7%), and redirection of fistula flow to pial venous reflux (n = 2, 2. 1%) . The average volume of Onyx used in TVCOE was 1.7 mL per CSDAVF. The mean coil lengths for TVCOE and TVCE were 143 and 228 cm, respectively, with a statistically significant difference (p < 0 .05) . Immediate digital subtraction angiography showed complete obliteration or nearly complete obliteration of CSDAVFs in TVCOE and TVCE at rates of 97.9% and 76.8%, respectively, indicating statistical significance in immediate complete obliteration (p < 0.05) . Transient hemodynamic instability occurred in 81 (90 .0%) patients due to Onyx toxicity, and one patient (1 . 1%) experienced hemorrhagic complications during TVCOE. Conclusion: The use of a small volume of Onyx as an adjunctive embolic material in TVCOE resulted in reduced coil use and improved immediate complete obliteration. This technique is viable for patients with pial venous reflux. Aside from the transient hemodynamic instability, periprocedural complications and follow-up angiographic outcomes did not show significant differences between the two groups. Keywords: Cavernous sinus dural arteriovenous fistula; Embolization; Onyx; Transvenous coil embolization; Treatment outcomes 1. INTRODUCTION Cavernous sinus dural arteriovenous fistulas (CSDAVFs) are abnormal connections between arteries and veins within the cavernous sinus, supplied by dural branches of the internal and/or external carotid arteries. Most CSDAVFs are low-flowshunts that exhibit antegrade flow to the inferior petrosal sinus (IPS) and retrograde flow to the ophthalmic vein. These fistulas typically manifest with benign orbital or cavernous symptoms.1,2 However, some CSDAVFs with restricted or inadequate *Address correspondence: Dr. Chien-Hui Lee, Department of Neurosurgery, Buddhist Tzu-Chi General Hospital and Tzu-Chi University, 707, Section 3, Chung-Yang Road, Hualien 970, Taiwan, ROC. E-mail address: fruitkinglch@gmail. com (C.H. Lee). Conflicts of interest: The authors declare that they have no conflicts of interest related to the subject matter or materials discussed in this article. Journal of Chinese Medical Association. (2025) 88: 261-266. Received April 6, 2024; accepted September 12, 2024. doi: 10. 1097/JCMA.0000000000001196 Copyright © 2024, the Chinese Medical Association. This is an open access article under the CC BY-NC-ND li

FAQs

What problem does this study address regarding TVCE for CSDAVFs?

Even though TVCE is effective, some patients have residual fistulas or worsening visual symptoms after the procedure. The study evaluates adding Onyx after coiling to address these issues.

How many patients and fistulas were included, and what follow-up duration was used?

The study included 207 patients with 222 CSDAVFs, with complete angiographic follow-up over 9 years. Ninety patients with 97 CSDAVFs underwent TVCOE after coiling.

What were the main reasons clinicians selected TVCOE and what outcomes were compared?

Key reasons included better immediate complete obliteration, presence of cranial nerve palsy, residual fistula with persistent pial venous reflux, and redirection of fistula flow. The paper compares clinical and angiographic outcomes between TVCOE and TVCE.

Sep 29, 2026

Uploaded by Aurelia