Combined covered stent and onyx treatment for complex dural arteriovenous fistula involving the clivus and cavernous sinus

Zhong Song Shi, Tie Wei Qi, Nestor R. Gonzalez, Jordan Ziegler, Zheng Song Huang

Research output: Contribution to journalArticlepeer-review

4 Scopus citations


Background: Complex DAVFs involving both the clivus and cavernous sinus are rare, especially when associated with brainstem compression from a large varix. In this report, we describe the use of a covered stent in combination with a liquid embolic agent to cure a complex clival-cavernous DAVF. Methods: A 46-year-old man presented with 6 months of dizziness, dysphagia, and progressive dysarthria. Magnetic resonance imaging showed tortuous and enlarged right cavernous and preclival flow voids. There were also bilateral prepontine varices compressing the ventral pons, which led to marked dorsal pontine edema. A cerebral angiogram revealed a clival DAVF supplied by multiple branches of the right ECA, as well as the MHT of the right ICA. Results: An endovascular cure was achieved by deploying a covered stent in the right cavernous ICA, followed by transarterial embolization of the feeding arteries originating from the ECA with Onyx (ev3, Irvine, Calif). This combined approach resulted in complete occlusion of the fistula. His 1-month follow-up angiogram confirmed persistent occlusion of the fistula and preserved patency of the right ICA. The patient made a full recovery without any new symptoms, and he remained neurologically intact at 18-month follow-up. Conclusion: The combined technique of covered stent placement and Onyx transarterial embolization is valuable for the management of complex DAVFs supplied by branches of both the external and internal carotid arteries.

Original languageEnglish (US)
Pages (from-to)169-174
Number of pages6
JournalSurgical Neurology
Issue number2
StatePublished - Aug 1 2009
Externally publishedYes


  • Covered stent
  • Dural arteriovenous fistula
  • Endovascular therapy
  • Liquid embolic material
  • Onyx

ASJC Scopus subject areas

  • Clinical Neurology
  • Surgery


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