Abstract
We report a case of tentorial dural arteriovenous fistula (dAVF) embolized using Onyx via a newly introduced microcatheter through a middle meningeal artery with a migrated Onyx plug.
A 44-year-old male was admitted to our hospital due to a generalized seizure. A tentorial dAVF fed by branches of the middle meningeal artery and the mastoid branch of the occipital artery was demonstrated on digital subtraction angiography. Transarterial embolization through a double-lumen balloon catheter (Scepter C) was performed using Onyx via the petrosquamous branch of the middle meningeal artery. However, the tip of the balloon catheter was occluded by an Onyx cast during the waiting period prior to Onyx injection. With the first injection, Onyx migrated into all accessible middle meningeal branches; therefore, we lost accessible branches for further embolization.
We tried to introduce a new microcatheter (Marathon) through the Onyx cast that migrated into the posterior convexity branch of the middle meningeal artery, anticipating the softness of Onyx injected into an artery. The microcatheter could be introduced easily through the Onyx cast and reached the portion close to the shunt point. Onyx injected through this microcatheter penetrated well into the vein though the shunt as well as other feeding arteries without making a new plug in the accessed artery despite the migrated Onyx cast. The dAVF was completely obliterated with this injection.
Introduction of a microcatheter through a migrated Onyx cast is possible, and Onyx is easily injected via the microcatheter without making a plug.
