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Transvenous balloon-protected embolization of a scalp arteriovenous fistula using Onyx liquid embolic

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Abstract

Background

Scalp arteriovenous fistulas (AVFs) are rare and potentially complex lesions that can be treated in a multimodal fashion. We present here the first successful treatment of a Stage Ib scalp AVF using a balloon-protected, retrograde transvenous embolization with the liquid embolic Onyx.

Method

We describe the case of a 60-year-old man with a scalp AVF that had a fine, diffuse, serpiginous arterial supply, precluding a transarterial approach, and multiple venous drainage paths, including the external jugular vein (EJV). The lesion was successfully embolized exclusively via a femoral transvenous retrograde approach using Onyx with balloon-protection of the EJV to simultaneously prevent pulmonary embolism and enable improved retrograde casting of the fistula-outflow zone.

Findings

The combined use of Onyx with proximal balloon-protection in a transvenous retrograde femoral approach is a novel method that can be used to definitively treat scalp AVFs with a defined catheter-accessible venous outflow.

Conclusion

This technique may be useful when transarterial embolization, direct puncture, or surgical excision are not practical or possible.

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References

  1. Arat A, Cil BE, Vargel I, Turkbey B, Canyigit M, Peynircioglu B, Arat YO (2007) Embolization of high-flow craniofacial vascular malformations with onyx. AJNR Am J Neuroradiol 28:1409–1414

    Article  PubMed  CAS  Google Scholar 

  2. Barnwell SL, Halbach VV, Dowd CF, Higashida RT, Hieshima GB (1989) Endovascular treatment of scalp arteriovenous fistulas associated with a large varix. Radiology 173:533–539

    PubMed  CAS  Google Scholar 

  3. Dogan S, Cinar C, Demirpolat G, Memis A (2008) Endovascular treatment of avf after hair transplantation. Cardiovasc Interv Radiol 31(Suppl 2):S128–S130

    Article  Google Scholar 

  4. Duncan IC, Fourie PA (2003) Circumferential flow reduction during percutaneous embolotherapy of extracranial vascular malformations: The “cookie-cutter” technique. AJNR Am J Neuroradiol 24:1453–1455

    PubMed  Google Scholar 

  5. Fisher-Jeffes ND, Domingo Z, Madden M, de Villiers JC (1995) Arteriovenous malformations of the scalp. Neurosurgery 36:656–660, discussion 660

    Article  PubMed  CAS  Google Scholar 

  6. Fukai J, Terada T, Kuwata T, Hyotani G, Raimura M, Nakagawa M, Yabumoto M, Kamei I (2001) Transarterial intravenous coil embolization of dural arteriovenous fistula involving the superior sagittal sinus. Surg Neurol 55:353–358

    Article  PubMed  CAS  Google Scholar 

  7. Gupta AK, Purkayastha S, Bodhey NK, Kapilamoorthy TR, Krishnamoorthy T, Kesavadas C, Thomas B (2008) Endovascular treatment of scalp cirsoid aneurysms. Neurol India 56:167–172

    Article  PubMed  CAS  Google Scholar 

  8. Hage ZA, Few JW, Surdell DL, Adel JG, Batjer HH, Bendok BR (2008) Modern endovascular and aesthetic surgery techniques to treat arteriovenous malformations of the scalp: case illustration. Surg Neurol 70:198–203, discussion 203

    Article  PubMed  Google Scholar 

  9. Heilman CB, Kwan ES, Klucznik RP, Cohen AR (1990) Elimination of a cirsoid aneurysm of the scalp by direct percutaneous embolization with thrombogenic coils. Case report. J Neurosurg 73:296–300

    Article  PubMed  CAS  Google Scholar 

  10. Hendrix LE, Meyer GA, Erickson SJ (1996) Cirsoid aneurysm treatment by percutaneous injection of sodium tetradecyl sulfate. Surg Neurol 46:557–560, discussion 560–551

    Article  PubMed  CAS  Google Scholar 

  11. Jahan R, Murayama Y, Gobin YP, Duckwiler GR, Vinters HV, Vinuela F (2001) Embolization of arteriovenous malformations with onyx: Clinicopathological experience in 23 patients. Neurosurgery 48:984–995, discussion 995–987

    Article  PubMed  CAS  Google Scholar 

  12. Khodadad G (1973) Arteriovenous malformations of the scalp. Ann Surg 177:79–85

    Article  PubMed  CAS  Google Scholar 

  13. Kumaran S, Nambi GI, Gupta AK (2008) Preventable complication after glue sclerotherapy for scalp arteriovenous malformation. J Plast Reconstr Aesthet Surg 61:854–855

    Article  PubMed  CAS  Google Scholar 

  14. Liu HM, Huang YC, Wang YH, Tu YK (2000) Transarterial embolisation of complex cavernous sinus dural arteriovenous fistulae with low-concentration cyanoacrylate. Neuroradiology 42:766–770

    Article  PubMed  CAS  Google Scholar 

  15. Matsushige T, Kiya K, Satoh H, Mizoue T, Kagawa K, Araki H (2004) Arteriovenous malformation of the scalp: case report and review of the literature. Surg Neurol 62:253–259

    Article  PubMed  Google Scholar 

  16. Muthukumar N, Rajagopal V, Manoharan AV, Durairaj N (2002) Surgical management of cirsoid aneurysms. Acta Neurochir (Wien) 144:349–356

    Article  CAS  Google Scholar 

  17. Nagasaka S, Fukushima T, Goto K, Ohjimi H, Iwabuchi S, Maehara F (1996) Treatment of scalp arteriovenous malformation. Neurosurgery 38:671–677, discussion 677

    Article  PubMed  CAS  Google Scholar 

  18. Phatouros CC, Meyers PM, Dowd CF, Halbach VV, Malek AM, Higashida RT (2000) Carotid artery cavernous fistulas. Neurosurg Clin N Am 11:67–84

    PubMed  CAS  Google Scholar 

  19. Ryu CW, Whang SM, Suh DC, Kim SM, Jang YJ, Kim HJ, Kim MJ, Chang SE, Hong JP, Kim SJ (2007) Percutaneous direct puncture glue embolization of high-flow craniofacial arteriovenous lesions: A new circular ring compression device with a beveled edge. AJNR Am J Neuroradiol 28:528–530

    PubMed  CAS  Google Scholar 

  20. Schechter MM, Gutstein RA (1970) Aneurysms and arteriovenous fistulas of the superficial temporal vessels. Radiology 97:549–557

    PubMed  CAS  Google Scholar 

  21. Schirmer CM, Zerris V, Malek AM (2006) Electrocautery-induced ignition of spark showers and self-sustained combustion of onyx ethylene-vinyl alcohol copolymer. Neurosurgery 59:ONS413–ONS418

    Article  PubMed  Google Scholar 

  22. Weber W, Kis B, Siekmann R, Jans P, Laumer R, Kuhne D (2007) Preoperative embolization of intracranial arteriovenous malformations with onyx. Neurosurgery 61:244–252, discussion 252–244

    Article  PubMed  Google Scholar 

  23. Whiteside OJ, Monksfield P, Steventon NB, Byrne J, Burton MJ (2005) Endovascular embolization of a traumatic arteriovenous fistula of the superficial temporal artery. J Laryngol Otol 119:322–324

    Article  PubMed  CAS  Google Scholar 

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Authors and Affiliations

  1. Cerebrovascular and Endovascular Division, Department of Neurosurgery Tufts Medical Center, Tufts University School of Medicine, 800 Washington Street, Proger 7, Boston, MA, 02111, USA

    Richard T. Z. Dalyai, Clemens M. Schirmer & Adel M. Malek

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  1. Richard T. Z. Dalyai
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  2. Clemens M. Schirmer
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  3. Adel M. Malek
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Correspondence to Adel M. Malek.

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Dalyai, R.T.Z., Schirmer, C.M. & Malek, A.M. Transvenous balloon-protected embolization of a scalp arteriovenous fistula using Onyx liquid embolic. Acta Neurochir 153, 1285–1290 (2011). https://doi.org/10.1007/s00701-011-0998-1

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  • DOI: https://doi.org/10.1007/s00701-011-0998-1

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