Case Reports and Description of Technique

SUMMARY: Three patients with spontaneous dural carotid-cavernous fistulas were treated by using a combination of detachable coils and Onyx liquid embolic agent. Cavernous sinus was accessed via the superior ophthalmic vein or inferior petrous sinus approach. In all cases, a complete angiographic closure of the fistulas was achieved with full recovery from neuro-ophthalmologic symptoms. This report suggests that the controlled and excellent penetration of Onyx is superb for blocking the intricate communication of dural carotid-cavernous fistulas. Ethylene-vinyl alcohol copolymer (EVOH) (Onyx, MicroTherapeutics, Irvine, Calif), is a nonadhesive liquid em-bolic agent that was evaluated at UCLA Medical Center be-tween January 1998 and May 1999. Experimental histopatho-logic research in swine rete mirabile had already been performed between 1997 and 1998.1,2 The FDA approved the intravascular use of Onyx for embolization of intracranial ar-teriovenous malformations (AVMs) in July 2005. This article details the use of Onyx intravasculary, in combination with detachable coils, in 3 cases of spontaneous cavernous dural arteriovenous fistulas