Successful Use of Neurovascular Plug for Embolization of Scalp Arteriovenous Fistula: A Novel Technique

Purpose: We report a case of a pediatric patient developing a delayed-onset scalp arteriovenous fistula (AVF) and pseudoaneurysm managed with a new technique. Technique: A 10-year-old boy presented to the outpatient clinic complaining of a growing pulsatile mass in the right side of the skull after head trauma 6 months ago. He had no neurological deficits. Imaging studies revealed scalp AVF with pseudoaneurysm. The arterial feeding was from the right temporal artery, while the blood was drained into the superior sagittal sinus and the facial vein. The fistula was occluded successfully by a microvascular plug (MVP). Follow-up angiography 1 year later showed that the AVF was no longer seen with complete embolization of pseudoaneurysm, total occlusion of the abnormal vessels, and the absence of MVP migration. Conclusion: To the best of our knowledge, we report the first case of successfully using MVP to treat scalp AVF. The MVP is a novel technique with its unique ability to achieve rapid, safe, effective, and permanent vascular occlusion through a single device. Besides, the possibility of delayed-onset traumatic vascular injuries should be considered in a patient with head or facial trauma.

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Traumatic arteriovenous fistula of the superficial temporal artery

Jornal Vascular Brasileiro ◽

10.1590/jvb.2014.008 ◽

2014 ◽

Vol 13 (1) ◽

pp. 39-42 ◽

Cited By ~ 1

Author(s):

Otacílio de Camargo Júnior ◽

Márcia Fayad Marcondes de Abreu ◽

Guilherme Camargo Gonçalves de Abreu ◽

Sthefano Atique Gabriel ◽

Isabella Maria Machado da Silva

Keyword(s):

Arteriovenous Fistula ◽

Superficial Temporal Artery ◽

Temporal Artery ◽

Surgical Removal ◽

Conventional Surgery ◽

Arteriovenous Fistulae ◽

Motorcycle Accident ◽

Pulsatile Mass ◽

Endovascular Methods ◽

The Right

Arteriovenous fistulae of the superficial temporal artery are rare, and their principal cause is traumas. Complications include pulsatile mass, headache, hemorrhage and deformities that compromise esthetics. Treatment can be performed using conventional surgery or endovascular methods. The authors describe a case of a 44-year-old male patient who developed a large pulsating mass, extending from the preauricular region to the right parietotemporal and frontal regions after a motorcycle accident. The treatment chosen was complete surgical removal of the pulsatile mass and ligature of the vessels feeding the fistula.

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Aneurysmen der distalen Arteria carotis externa

VASA ◽

10.1024/0301-1526.29.1.87 ◽

2000 ◽

Vol 29 (1) ◽

pp. 87-88 ◽

Cited By ~ 2

Author(s):

Vassilios G. Papavassiliou ◽

Liapis ◽

Kakissis ◽

Safioleas ◽

Kaperonis ◽

...

Keyword(s):

Carotid Artery ◽

Superficial Temporal Artery ◽

Temporal Artery ◽

External Carotid Artery ◽

External Carotid ◽

Traumatic Aneurysm ◽

First Case ◽

Pulsatile Mass ◽

Posterior Auricular Artery ◽

The Right

Aneurysms of the distal branches of the external carotid artery are rare and usually traumatic in origin. We present two cases which were treated in our clinic. The first case is about a traumatic aneurysm of the left superficial temporal artery (STA) in a young boy 8 years old. The young patient developed a pulsatile mass above his left eyebrow ten days after a bite by a boy of the same age. The second case is referred in a 36-year old woman with a pulsatile mass behind the right ear, which was an aneurysm of the posterior auricular artery. The treatment was ligation and resection under local anesthesia in the first case and under general anesthesia in the latter. Surgeons’ familiarity with this entity is important for diagnosis and treatment.

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Single Hole High Flow Arteriovenous Fistula

Interventional Neuroradiology ◽

10.1177/159101990200800110 ◽

2002 ◽

Vol 8 (1) ◽

pp. 55-60 ◽

Cited By ~ 7

Author(s):

C. Campos ◽

R. Piske ◽

J. Nunes ◽

S.B. Soares ◽

J.A. Castro ◽

...

Keyword(s):

Arteriovenous Fistula ◽

Fatal Outcome ◽

High Flow ◽

Total Occlusion ◽

Single Hole ◽

Therapeutic Guidelines ◽

Venous Ectasia ◽

Pial Arteriovenous Fistula ◽

Glue Injection ◽

The Right

A high flow pial arteriovenous fistula in a twenty-years-old girl is described. The arteriovenous communication corresponds to a single hole fistula on the right rolandic area, with a giant venous ectasia. The patient presented seizures and left hemiparesis as symptoms. The fistula was embolized with glue obtaining total occlusion of the shunt. Hypotension was induced and valsalva manoeuver was done during the glue injection to reduce the flow into the fistula, however 26 hours after the procedure the patient bled resulting in a fatal outcome. The purpose of this paper is discuss the presentation of Rendu-Osler-Weber (ROW) in children and the therapeutic guidelines.

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Delayed-onset unilateral Vogt-Koyanagi-Harada syndrome: a multimodal imaging appraisal

BMJ Case Reports ◽

10.1136/bcr-2020-238623 ◽

2021 ◽

Vol 14 (2) ◽

pp. e238623

Author(s):

Saurabh Verma ◽

Himani Thakur ◽

Shorya Vardhan Azad ◽

Vinod Kumar

Keyword(s):

Multimodal Imaging ◽

Intravitreal Bevacizumab ◽

Choroidal Neovascularisation ◽

Enhanced Depth Imaging ◽

Depth Imaging ◽

Delayed Onset ◽

First Case ◽

Imaging Optical Coherence Tomography ◽

The Right ◽

Active Inflammation

A 38-year-old woman who had previously been diagnosed and treated for unilateral Vogt-Koyanagi-Harada syndrome (VKH) and had undergone multiple intravitreal bevacizumab injections to manage inflammatory choroidal neovascularisation in her right eye, presented 2 years later with visual complains in left eye. Clinical examination, fluorescein angiography, indocyanine green angiography (ICGA) and enhanced depth imaging optical coherence tomography (EDI-OCT) assisted evaluation confirmed active inflammation of left eye along with absence of any inflammation in the right eye. Unilateral active inflammation can be seen in the setting of VKH. To our best knowledge, ours is the first case of VKH in which unilateral active inflammation has been proven based on ICGA and EDI OCT analysis.

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A case of pediatric paraspinal arteriovenous fistula with multiple fistulas

Interventional Neuroradiology ◽

10.1177/1591019920957915 ◽

2020 ◽

pp. 159101992095791

Author(s):

Shinsuke Sato ◽

Yasunari Niimi ◽

Shougo Shima ◽

Yousuke Moteki ◽

Tatuya Inoue ◽

...

Keyword(s):

Arteriovenous Fistula ◽

Selective Angiography ◽

Neural Foramen ◽

Minimum Intensity Projection ◽

First Case ◽

Segmental Nerve ◽

Chest Auscultation ◽

The Right ◽

Enhanced Computed Tomography ◽

Minimum Intensity

Paraspinal arteriovenous fistula (AVF) is a rare vascular malformation. This is the first described case of a pediatric paraspinal AVF along nonvertebral segmental nerve with multiple fistulas. An 8 months-old girl was found to have a continuous murmur on the back on chest auscultation. Enhanced computed tomography revealed a segmental nerve AVF of the right thoracic spine. Selective angiography of the right T8 and T9 intercostal arteries demonstrated a high flow fistula at the level of the neural foramen, with drainage to the epidural and azygos veins. The fistulas point was visualized using Volume rendering(VR) and Minimum Intensity Projection(MIP) images. Endovascular treatment from the right T8 and T9 feeding arteries was provided using coils and n-butyl-2-cyanoacrylate(NBCA). Postembolization angiography demonstrated complete occlusion of the fistulas. The postoperative course was uneventful. We discuss the first case of a pediatric paraspinal AVF along nonvertebral segmental nerve with double holes of fistulas with literature review.

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THUR 149 ANCA/MPO vasculitis presenting with bilateral ischaemic optic neuropathy

Journal of Neurology Neurosurgery & Psychiatry ◽

10.1136/jnnp-2018-abn.63 ◽

2018 ◽

Vol 89 (10) ◽

pp. A17.3-A17

Author(s):

Mehta Dwij ◽

Wade Charles

Keyword(s):

Visual Acuity ◽

Optic Neuropathy ◽

Temporal Artery ◽

Neurological Deficits ◽

Temporal Artery Biopsy ◽

Meningeal Enhancement ◽

Csf Analysis ◽

Ischaemic Optic Neuropathy ◽

Systemic Symptoms ◽

The Right

An 80 year old gentleman presented with bilateral, sequential ischaemic optic neuropathy. He initially developed progressive loss of vision in left eye with loss of colour vision and subsequently developed similar symptoms in the right eye with headaches, weight loss, malaise and lethargy. His visual acuity dropped to 6/12 on the right and counting fingers on the left. He had a dense central scotoma in left eye with left-sided RAPD but no other focal neurological deficits.Blood tests revealed an ESR of 107 with an MPO ANCA titre of 19. MRI brain with contrast showed prominent meningeal enhancement and infiltration with ischaemic changes in the brain. CSF analysis revealed WCC of 24 (95% lymphocytes), RCC 22 and protein 0.4 g/L with negative bacterial culture. Temporal artery biopsy was normal.He was treated initially with IV methylprednisolone and 6 cycles of IV cyclophosphamide and subsequently put on methotrexate. His systemic symptoms have resolved completely and his visual acuity continues to gradually improve.MPO-ANCA vasculitis can mimic temporal arteritis and should be considered in patients presenting with an ischaemic optic neuropathy. It is also a treatable cause of meningeal disease.

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Treatment of bilateral mycotic intracavernous carotid aneurysms

Journal of Neurosurgery ◽

10.3171/jns.1982.56.3.0443 ◽

1982 ◽

Vol 56 (3) ◽

pp. 443-447 ◽

Cited By ~ 27

Author(s):

Tsuneyoshi Eguchi ◽

Tadayoshi Nakagomi ◽

Akira Teraoka

Keyword(s):

Internal Carotid ◽

Superficial Temporal Artery ◽

Temporal Artery ◽

Systemic Blood Pressure ◽

Neurological Deficits ◽

Systemic Blood ◽

Content Type ◽

Carotid Aneurysms ◽

The Right ◽

Fine Print

✓ A case of bilateral mycotic intracavernous carotid aneurysms is reported. Because of progressive bilateral ophthalmoplegia, the internal carotid artery (ICA) was ligated on both sides, combined with bilateral extracranial-intracranial arterial bypass. A superficial temporal artery-middle cerebral artery anastomosis was performed first on the right side followed by ligation of the right ICA at the neck. After an interval of 20 days, a bypass and ICA ligation was carried out on the left side. The patient developed mild hemiparesis and dysphasia during and immediately after the second operation, but these neurological deficits disappeared after elevation of systemic blood pressure.

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Repair of a Combined Femoral Pseudoaneurysm and Arteriovenous Fistula Using a Covered Stent Graft

The American Surgeon ◽

10.1177/000313480707300306 ◽

2007 ◽

Vol 73 (3) ◽

pp. 227-229 ◽

Cited By ~ 1

Author(s):

Aaron S. Kendrick ◽

L. Richard Sprouse

Keyword(s):

Arteriovenous Fistula ◽

Duplex Ultrasound ◽

Covered Stent ◽

Invasive Treatment ◽

Peripheral Vasculature ◽

Pulsatile Mass ◽

Elective Setting ◽

Complete Exclusion ◽

Covered Stent Graft ◽

The Right

Our purpose was to demonstrate clinical efficacy of covered stent use in the peripheral vasculature. A 68-year-old man was transferred from an outlying hospital for evaluation and treatment of a pulsatile mass in his right groin after cardiac catheterization. Imaging with duplex ultrasound and diagnostic arteriogram demonstrated a 6-cm pseudoaneurysm (PSA) of the right superficial femoral artery (SFA) and an arteriovenous fistula (AVF) of the SFA and the profunda vein. Using a covered stent extending from the proximal SFA across the origins of the AVF and PSA, complete exclusion was attained. Follow-up ultrasound at 6 weeks revealed a patent stent, no AVF, and thrombosis of the PSA. Endovascular treatment of peripheral lesions (AVF/PSA) in an elective to semi-elective setting offers patients a safe, less invasive treatment option to consider over traditional open surgery. Consequently, a formidable reduction in incision length, wound infection, and postoperative immobility can be expected.

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Perimedullary Arteriovenous Fistula of the Filum Terminale

Neurosurgery ◽

10.1227/01.neu.0000359529.40577.a1 ◽

2010 ◽

Vol 66 (1) ◽

pp. E219-E220 ◽

Cited By ~ 25

Author(s):

Yong Jun Jin ◽

Ki-Jeong Kim ◽

O Ki Kwon ◽

Sang Ki Chung

Keyword(s):

Arteriovenous Fistula ◽

Transarterial Embolization ◽

Conus Medullaris ◽

Leg Pain ◽

Anterior Spinal Artery ◽

Filum Terminale ◽

Segmental Artery ◽

First Case ◽

History Of ◽

The Right

Abstract OBJECTIVE Although a dural or intramedullary arteriovenous fistula involving the conus medullaris and fed by the lateral sacral artery has been reported, a case of perimedullary fistula arising from an artery in the filum terminale has not been described in the literature. The authors report the first case of perimedullary arteriovenous fistula located in the filum terminale. CLINICAL PRESENTATION A 61-year-old man presented with a 10-year history of leg pain. Thoracolumbar magnetic resonance imaging scans revealed multiple perimedullary signal voids from T10 to L3. Angiography showed engorged perimedullary veins and a fistula fed by the anterior spinal artery from the right ninth segmental artery and by 2 branches of the left lateral sacral artery. The anterior spinal artery was also regarded as the artery of the filum terminale. INTERVENTION Transarterial embolization was performed to occlude the feeders from the left lateral sacral artery, and an L5 total laminectomy was subsequently performed to obliterate residual fistulous material from the artery of the filum terminale. The thickened, yellowish filum, surrounded by tortuous, engorged veins, was coagulated and resected. Postoperatively, the patient's symptoms gradually resolved and were not aggravated during long periods of walking. CONCLUSION It must be noted that a fistula can be located in the filum terminale and can be successfully treated using multidisciplinary approaches.

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Treatment of a supratentorial primitive neuroectodermal tumor using magnetic resonance–guided laser-induced thermal therapy

Journal of Neurosurgery Pediatrics ◽

10.3171/2011.8.peds11148 ◽

2011 ◽

Vol 8 (5) ◽

pp. 468-475 ◽

Cited By ~ 40

Author(s):

Pinakin R. Jethwa ◽

Jason H. Lee ◽

Rachid Assina ◽

Irwin A. Keller ◽

Shabbar F. Danish

Keyword(s):

Thermal Ablation ◽

Late Recurrence ◽

Extent Of Resection ◽

Thermal Therapy ◽

Neurological Deficits ◽

Promising Tool ◽

First Case ◽

Supratentorial Pnet ◽

The Right

Supratentorial primitive neuroectodermal tumors (PNETs) are rare tumors that carry a poorer prognosis than those arising from the infratentorial compartment (such as medulloblastoma). The overall prognosis for these patients depends on several factors including the extent of resection, age at diagnosis, CSF dissemination, and site in the supratentorial space. The authors present the first case of a patient with a newly diagnosed supratentorial PNET in which cytoreduction was achieved with MR-guided laser-induced thermal therapy. A 10-year-old girl presented with left-sided facial weakness and a large right thalamic mass extending into the right midbrain. The diagnosis of supratentorial PNET was made after stereotactic biopsy. Therapeutic options for this lesion were limited because of the risks of postoperative neurological deficits with resection. The patient underwent MR-guided laser-induced thermal ablation of her tumor. Under real-time MR thermometry, thermal energy was delivered to the tumor at a core temperature of 90°C for a total of 960 seconds. The patient underwent follow-up MR imaging at regular intervals to evaluate the tumor response to the thermal ablation procedure. Initial postoperative scans showed an increase in the size of the lesion as well as the amount of the associated edema. Both the size of the lesion and the edema stabilized by 1 week and then decreased below preablation levels at the 3-month postsurgical follow-up. There was a slight increase in the size of the lesion and associated edema at the 6-month follow-up scan, presumably due to concomitant radiation she received as part of her postoperative care. The patient tolerated the procedure well and has had resolution of her symptoms since surgery. Further study is needed to assess the role of laser-induced thermal therapy for the treatment of intracranial tumors. As such, it is a promising tool in the neurosurgical armamentarium. Postoperative imaging has shown no evidence of definitive recurrence at the 6-month follow-up period, but longer-term follow-up is required to assess for late recurrence.

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