Ear Necrosis Resulting from the Endovascular Onyx-18 Embolization of a Dural Arteriovenous Fistula Fed by the Posterior Auricular Artery

BACKGROUND AND PURPOSE The treatment of a dural arteriovenous fistula (DAVF) can involve surgery, radiosurgery, or endovascular embolization. New embolization techniques and agents have expanded the role of endovascular treatment. METHODS We report the endovascular embolization with Onyx-18 of a DAVF fed by the posterior auricular artery. RESULTS The DAVF was successfully embolized; however, the patient's ear developed ischemic necrosis of the superolateral pinna. CONCLUSIONS Onyx-18 can provide high rates of success in the treatment of DAVFs in well-selected patients. Risks of end organ ischemia must be considered during endovascular embolization and when counseling patients regarding procedural risk. J Neuroimaging 2009;19:259-262.