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CC BY-NC-ND 4.0 · Asian J Neurosurg 2022; 17(02): 337-341
DOI: 10.1055/s-0042-1750386
Case Report

Feasibility of Metal Artifact Reduction on CT Angiography for Planning Direct Surgery of Tentorial dAVF after Onyx Embolization

Kanji Nakagawa
1   Department of Neurosurgery, Kansai Rosai Hospital, Amagaski, Hyogo, Japan
,
Shingo Toyota
1   Department of Neurosurgery, Kansai Rosai Hospital, Amagaski, Hyogo, Japan
,
Takeshi Shimizu
1   Department of Neurosurgery, Kansai Rosai Hospital, Amagaski, Hyogo, Japan
,
Tomoaki Murakami
1   Department of Neurosurgery, Kansai Rosai Hospital, Amagaski, Hyogo, Japan
,
Takuyu Taki
1   Department of Neurosurgery, Kansai Rosai Hospital, Amagaski, Hyogo, Japan
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Abstract

Although Onyx is approved as an embolic material for arteriovenous malformation (AVM) and dural arteriovenous fistula (dAVF), metal artifacts due to Onyx on CT remain problematic. We report the feasibility of a metal artifact reduction (MAR) algorithm on CT angiography (CTA) in the planning of direct surgery of dAVF after transarterial Onyx embolization. A 45-year-old male patient presented with right pulsatile tinnitus, and cerebral angiography demonstrated right tentorial dAVF. As the dAVF had not completely disappeared even after Onyx transarterial embolization, we planned direct surgery. Evaluation of the lesion was difficult on normal preoperative CTA because of Onyx artifacts, but CTA using MAR enabled a detailed planning of direct surgery. Direct surgery was performed through right retrosigmoid craniotomy. Referencing CTA using MAR, we identified the draining veins originating from the main drainer, which were coagulated and cut, achieving complete occlusion of the dAVF. His symptoms disappeared with no postoperative complications. CT angiography using MAR was useful for planning direct surgery after Onyx embolization. As the incidence of direct surgery after transarterial Onyx embolization for AVM or dAVF is increasing, MAR on CTA will become more important.

Keywords

direct surgery - tentorial dAVF - Onyx embolization - smart metal artifact reduction


Publication History

Article published online:
25 August 2022

© 2022. Asian Congress of Neurological Surgeons. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)

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  • References

  • 1 Elsenousi A, Aletich VA, Alaraj A. Neurological outcomes and cure rates of embolization of brain arteriovenous malformations with n-butyl cyanoacrylate or Onyx: a meta-analysis. J Neurointerv Surg 2016; 8 (03) 265-272
    CrossrefPubMedGoogle Scholar
  • 2 Sadeh-Gonike U, Magand N, Armoiry X. et al. Transarterial Onyx embolization of intracranial dural fistulas: a prospective cohort, systematic review, and meta-snalysis. Neurosurgery 2018; 82 (06) 854-863
    CrossrefPubMedGoogle Scholar
  • 3 Vollherbst DF, Otto R, Do T. et al. Imaging artifacts of Onyx and PHIL on conventional CT, cone-beam CT and MRI in an animal model. Interv Neuroradiol 2018; 24 (06) 693-701
    CrossrefPubMedGoogle Scholar
  • 4 Pop R, Mertz L, Ilyes A. et al. Beam hardening artifacts of liquid embolic agents: comparison between Squid and Onyx. J Neurointerv Surg 2019; 11 (07) 706-709
    CrossrefPubMedGoogle Scholar
  • 5 Borden JA, Wu JK, Shucart WA. A proposed classification for spinal and cranial dural arteriovenous fistulous malformations and implications for treatment. J Neurosurg 1995; 82 (02) 166-179
    CrossrefPubMedGoogle Scholar
  • 6 Cognard C, Gobin YP, Pierot L. et al. Cerebral dural arteriovenous fistulas: clinical and angiographic correlation with a revised classification of venous drainage. Radiology 1995; 194 (03) 671-680
    CrossrefPubMedGoogle Scholar
  • 7 Lawton MT, Sanchez-Mejia RO, Pham D, Tan J, Halbach VV. Tentorial dural arteriovenous fistulae: operative strategies and microsurgical results for six types. Neurosurgery 2008; 62 (03, Suppl 1): discussion 124–125 110-124
    PubMedGoogle Scholar
  • 8 Byrne JV, Garcia M. Tentorial dural fistulas: endovascular management and description of the medial dural-tentorial branch of the superior cerebellar artery. AJNR Am J Neuroradiol 2013; 34 (09) 1798-1804
    CrossrefPubMedGoogle Scholar
  • 9 Awad IA, Little JR, Akarawi WP, Ahl J. Intracranial dural arteriovenous malformations: factors predisposing to an aggressive neurological course. J Neurosurg 1990; 72 (06) 839-850
    CrossrefPubMedGoogle Scholar
  • 10 van Dijk JM, terBrugge KG, Willinsky RA, Wallace MC. Clinical course of cranial dural arteriovenous fistulas with long-term persistent cortical venous reflux. Stroke 2002; 33 (05) 1233-1236
    CrossrefPubMedGoogle Scholar
  • 11 Takeuchi S, Kawaguchi T, Nakatani M, Satou K. Two cases of tentorial dural arteriovenous fistula successfully managed by gamma knife radiosurgery. Surg Cereb Stroke (Jpn) 2009; 37 (05) 384-389
    CrossrefGoogle Scholar
  • 12 Lv X, Jiang C, Li Y, Yang X, Wu Z. Transarterial embolization of tentorial dural arteriovenous fistulas with onyx 18. Neuroradiol J 2008; 21 (03) 406-414
    CrossrefPubMedGoogle Scholar
  • 13 Puffer RC, Daniels DJ, Kallmes DF, Cloft HJ, Lanzino G. Curative Onyx embolization of tentorial dural arteriovenous fistulas. Neurosurg Focus 2012; 32 (05) E4
    CrossrefPubMedGoogle Scholar
  • 14 Kim HJ, Yang JH, Lee HJ, Lee HJ. Tentorial dural arteriovenous fistula treated using transarterial Onyx embolization. J Korean Neurosurg Soc 2015; 58 (03) 276-280
    CrossrefPubMedGoogle Scholar
  • 15 Huang Q, Xu Y, Hong B, Li Q, Zhao W, Liu J. Use of onyx in the management of tentorial dural arteriovenous fistulae. Neurosurgery 2009; 65 (02) 287-292 , discussion 292–293
    CrossrefPubMedGoogle Scholar
  • 16 Kortman HG, Boukrab I, Bloemsma G. et al. Tentorial dural arteriovenous fistulas: a single-center cohort of 12 patients. J Cerebrovasc Endovasc Neurosurg 2017; 19 (04) 284-290
    CrossrefPubMedGoogle Scholar
  • 17 Tomak PR, Cloft HJ, Kaga A, Cawley CM, Dion J, Barrow DL. Evolution of the management of tentorial dural arteriovenous malformations. Neurosurgery 2003; 52 (04) 750-760 , discussion 760–762
    CrossrefPubMedGoogle Scholar
  • 18 Cognard C, Januel AC, Silva Jr NA, Tall P. Endovascular treatment of intracranial dural arteriovenous fistulas with cortical venous drainage: new management using Onyx. Am J Neuroradiol 2008; 29 (02) 235-241
    CrossrefPubMedGoogle Scholar
  • 19 Nogueira RG, Dabus G, Rabinov JD. et al. Preliminary experience with onyx embolization for the treatment of intracranial dural arteriovenous fistulas. Am J Neuroradiol 2008; 29 (01) 91-97
    CrossrefPubMedGoogle Scholar
  • 20 Biswas S, Chandran A, Radon M. et al. Accuracy of four-dimensional CT angiography in detection and characterisation of arteriovenous malformations and dural arteriovenous fistulas. Neuroradiol J 2015; 28 (04) 376-384
    CrossrefPubMedGoogle Scholar
  • 21 Paolini S, Lanzino G, Colonnese C, Venditti E, Cantore G, Esposito V. Three-dimensional computed tomography angiography in presurgical planning for treatment of infratentorial dural arteriovenous fistulas. J Neurosurg 2009; 110 (01) 85-89
    CrossrefPubMedGoogle Scholar
  • 22 Sunwoo L, Park SW, Rhim JH. et al. Metal artifact reduction for orthopedic implants: brain CT angiography in patients with intracranial metallic implants. J Korean Med Sci 2018; 33 (21) e158
    CrossrefPubMedGoogle Scholar
  • 23 Huang JY, Kerns JR, Nute JL. et al. An evaluation of three commercially available metal artifact reduction methods for CT imaging. Phys Med Biol 2015; 60 (03) 1047-1067
    Google Scholar
  • 24 Mennecke A, Svergun S, Scholz B, Royalty K, Dörfler A, Struffert T. Evaluation of a metal artifact reduction algorithm applied to post-interventional flat detector CT in comparison to pre-treatment CT in patients with acute subarachnoid haemorrhage. Eur Radiol 2017; 27 (01) 88-96
    CrossrefPubMedGoogle Scholar
  • 25 Pjontek R, Önenköprülü B, Scholz B. et al. Metal artifact reduction for flat panel detector intravenous CT angiography in patients with intracranial metallic implants after endovascular and surgical treatment. J Neurointerv Surg 2016; 8 (08) 824-829
    CrossrefPubMedGoogle Scholar
  • 26 Prell D, Kyriakou Y, Struffert T, Dörfler A, Kalender WA. Metal artifact reduction for clipping and coiling in interventional C-arm CT. Am J Neuroradiol 2010; 31 (04) 634-639
    CrossrefPubMedGoogle Scholar
  • 27 Kidoh M, Utsunomiya D, Ikeda O. et al. Reduction of metallic coil artefacts in computed tomography body imaging: effects of a new single-energy metal artefact reduction algorithm. Eur Radiol 2016; 26 (05) 1378-1386
    CrossrefPubMedGoogle Scholar
  • 28 Guilfoile C, Rampant P, House M. The impact of smart metal artefact reduction algorithm for use in radiotherapy treatment planning. Australas Phys Eng Sci Med 2017; 40 (02) 385-394
    CrossrefPubMedGoogle Scholar
  • 29 Kuroda H, Toyota S, Kumagai T. et al. Feasibility of smart metal artifact reduction algorithm on computed tomography angiography for clipping of recurrent aneurysms after coil embolization. World Neurosurg 2019; 127: e1249-e1254
    CrossrefPubMedGoogle Scholar