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Treatment of intracranial dural fistulas with Onyx : a prospective cohort, systematic review, and meta-analysis

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Sadeh-Gonik, Udi, Magand, Nicolas, Armoiry, Xavier, Riva, Roberto, Labeyrie, Paul-Emile, Lamy, Bernadette, Lukaszewicz, Anne-Claire, Lehot, Jean-Jacques, Turjman, Francis and Gory, Benjamin (2017) Treatment of intracranial dural fistulas with Onyx : a prospective cohort, systematic review, and meta-analysis. Neurosurgery, 82 (6). pp. 854-863. doi:10.1093/neuros/nyx309 ISSN 0148-396X.

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Official URL: https://doi.org/10.1093/neuros/nyx309

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Abstract

BACKGROUND
Onyx is important embolic material in the endovascular treatment of intracranial dural arteriovenous fistula (DAVF). However, its impact on DAVF occlusion rates, morbidity, mortality, and complication rates is not fully examined.

OBJECTIVE
To improve understanding of safety and effectiveness profiles associated with transarterial endovascular treatment using Onyx for intracranial DAVF

METHODS
We analyzed data from our prospective clinical registry and conducted a systematic review of all previous transarterial embolization studies using Onyx published between January 2005 and December 2015 in MEDLINE and EMBASE.

RESULTS
In the prospective study, 41 transarterial procedures were performed in 33 consecutive patients harboring 36 DAVFs. Complete initial exclusion was obtained in 32 of 36 (88.9%) fistulas; 31 fistulas were followed up showing 4 (12.9%) recurrences. Procedure-related morbidity and mortality were 3% and 0%, respectively. The literature review identified 19 studies involving a total of 425 patients with 463 DAVFs. Meta-analysis, including our registry data, showed an initial complete occlusion rate of 82% (95% confidence interval [CI]: 74%, 88%; I2, 70.6%), and recurrence rate at midterm of 2% (95% CI: 0%, 5%; I2, 21.5%). Pooled postoperative neurological deficit, procedure-related morbidity, and mortality rates were 4% (95% CI: 2%, 6%; I2, 0%), 3% (95% CI: 1%, 5%; I2, 0%), and 0%, respectively.

CONCLUSION
This meta-analysis suggests that transarterial embolization with Onyx is a safe treatment modality for DAVFs. Although Onyx showed a low recurrence rate at midterm, the long-term risk is poorly addressed in our study and should warrant a longer follow-up.

Item Type: Journal Article
Subjects: R Medicine > RC Internal medicine
R Medicine > RD Surgery
Divisions: Faculty of Science, Engineering and Medicine > Medicine > Warwick Medical School > Health Sciences
Faculty of Science, Engineering and Medicine > Medicine > Warwick Medical School > Health Sciences > Population, Evidence & Technologies (PET)
Faculty of Science, Engineering and Medicine > Medicine > Warwick Medical School
Library of Congress Subject Headings (LCSH): Blood-vessels -- Endoscopic surgery, Fistula, Arteriovenous
Journal or Publication Title: Neurosurgery
Publisher: Lippincott Williams & Wilkins
ISSN: 0148-396X
Official Date: 1 June 2017
Dates:
DateEvent
1 June 2017Published
17 June 2017Available
11 May 2017Accepted
Volume: 82
Number: 6
Page Range: pp. 854-863
DOI: 10.1093/neuros/nyx309
Status: Peer Reviewed
Publication Status: Published
Access rights to Published version: Open Access (Creative Commons)
Date of first compliant deposit: 28 March 2017
Date of first compliant Open Access: 17 June 2018
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