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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
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WRAP-treatment-intracranial-dural-fistulas-onyx-Armoiry-2017.pdf - Accepted Version - Requires a PDF viewer. Download (2873Kb) | Preview |
Official URL: https://doi.org/10.1093/neuros/nyx309
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 | ||||||||
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| Subjects: | R Medicine > RC Internal medicine R Medicine > RD Surgery |
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| Divisions: | Faculty of Medicine > Warwick Medical School > Health Sciences Faculty of Medicine > Warwick Medical School > Health Sciences > Population, Evidence & Technologies (PET) Faculty of Medicine > Warwick Medical School |
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| 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: |
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| Date of first compliant deposit: | 28 March 2017 | ||||||||
| 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 | ||||||||
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