From the Guidelines
Glue embolization is a highly effective treatment for dural arteriovenous fistulas (dAVFs), offering a minimally invasive approach with high success rates and lower complication rates compared to surgery, as supported by the American Heart Association's scientific statement 1. The procedure involves injecting a liquid embolic agent into the abnormal blood vessel connections to seal them off, and is typically performed by an interventional neuroradiologist.
- The treatment is usually performed under general anesthesia and takes 2-4 hours to complete.
- Success rates range from 70-90% depending on fistula complexity, with complete obliteration often achieved in a single session, as noted in the context of endovascular treatment for dural AVMs 1.
- Patients usually stay in the hospital for 1-2 days post-procedure, and potential complications include stroke, vessel perforation, and non-target embolization. Key benefits of glue embolization for dAVFs include:
- Minimally invasive approach
- High success rates
- Lower complication rates compared to surgery
- Ability to alleviate symptoms like pulsatile tinnitus, headaches, and neurological deficits
- Physical occlusion of abnormal connections, preventing high-pressure arterial blood from flowing directly into veins, thus reducing the risk of hemorrhage, as described in the context of endovascular techniques for curative occlusion of certain pediatric fistulas, including the vein of Galen malformation 1.
From the Research
Glue Embolization in Dural AV Fistula
- Glue embolization is a treatment option for dural arteriovenous fistulas (DAVFs), particularly for smaller recurrent feeders that can fill in the Onyx recanalized cast 2.
- The use of glue embolization with a guide catheter dextrose push has been shown to be effective in treating DAVFs, especially in cases where Onyx has failed to achieve complete occlusion 2.
- A study published in the Journal of Neurosurgery found that the overall initial angiographic occlusion rate for DAVFs treated with endovascular approaches was 70%, with a recurrence or occult residual lesion rate of 3% 3.
- The same study found that the introduction of Onyx led to a significant increase in the initial angiographic occlusion rate, from 60% to 76% 3.
- Another study published in Neurosurgical Focus presented a case of staged transarterial endovascular embolization of a malignant DAVF using Onyx and n-butyl cyanoacrylate, highlighting the effectiveness of this approach in treating complex DAVFs 4.
- A study published in Neurosurgery found that transarterial embolization using liquid embolic agents, including Onyx and n-butyl cyanoacrylate, was effective in treating clival DAVFs, with a complete angiographic obliteration rate of 50% 5.
- A study published in Neurologia Medico-Chirurgica found that transarterial acrylic glue embolization was highly effective for Borden type III DAVFs with direct cortical venous drainage, but had limitations for Borden type I and II DAVFs 6.
Comparison of Glue Embolization with Other Treatments
- Glue embolization has been compared to Onyx embolization, with benefits including high thrombogenicity and relatively low risks of cranial nerve palsies and excessive migration into the draining veins of high flow fistula 6.
- However, Onyx is becoming the treatment of choice for DAVF due to its slower and more controlled injections, as well as better penetration via radial casting 2.
Clinical Outcomes and Complications
- The overall complication rate for endovascular treatment of DAVFs was 8%, with permanent neurological complications occurring in 3% of cases 3.
- A study published in Neurologia Medico-Chirurgica found that complications occurred in 9% of patients treated with transarterial glue embolization, consisting of asymptomatic vessel perforations and leakage of contrast medium resulting in medullary infarction 6.