Onyx embolization for tentorial dural arteriovenous fistula with pial arterial supply: case series and analysis of complications.

OBJECTIVE: We describe treatment with Onyx embolization in a series of cases of tentorial dural arteriovenous fistula (DAVF) with pial arterial supply. The aim of this study was to analyze the cause of intraoperative hemorrhage and to explore therapeutic strategies. METHODS: Retrospective review was performed of 53 consecutive patients with DAVF treated by Onyx embolization between February 2009 and December 2014. Tentorial DAVF with pial arterial supply was diagnosed in 6 patients (2 women and 4 men; mean age, 47.3 years +/- 10.2), and transarterial Onyx embolization was performed in these patients. Fisher exact test was used to analyze differences of incidence of procedure-related complications. RESULTS: Intraoperative hemorrhage occurred in 2 of 6 patients with pial arterial supply. One patient died as a result of hemorrhage, and the other patient survived after craniotomy. The incidence of complications for these 6 patients (2 of 6; 33.3%) was significantly higher (P = 0.0309) compared with patients with DAVF without pial arterial supply (1 of 47; 2.1%). CONCLUSIONS: Pial arterial supply may be a risk factor for intraoperative hemorrhage during transarterial embolization of DAVF through dural feeders. Identification of pial feeders and early superselective occlusion of such feeders are important for safe management.