Efficacy of Transarterial Embolization Using Intermittent Flow Control for Tentorial Dural Arteriovenous Fistula Presenting as Myelopathy: A Technical Report.

Background: Transarterial embolization (TAE) is generally the endovascular treatment of choice for tentorial dural arteriovenous fistula (dAVF). Although flow control of the feeder vessel has been reported to achieve complete shunt blockade, flow control in the absence of ischemia tolerance of internal carotid artery as a feeder has not been reported. We present a case in which treatment by Onyx TAE with intermittent flow control of the meningohypophyseal trunk as the feeder was successful for a tentorial dAVF presenting with myelopathy without tolerance of ischemia.

Methods: The intermittent flow control is presented for a tentorial dAVF presenting with myelopathy without tolerance for ischemia. An inflation of the balloon in the internal carotid artery was set for 5 minutes, and the Onyx injection was repeated at intervals of at least 2 minutes. Injections and pauses were repeated to allow Onyx to reach the shunt pouch.

Results: The patient underwent successful TAE with intermittent flow control for a tentorial dAVF presenting with myelopathy. The disappearance of the shunt was confirmed with gait disturbance resolution postoperatively.

Conclusions: Intermittent flow control of the meningohypophyseal trunk using a balloon may be safe and effective for cases showing no tolerance for ischemia.