Yokouchi T, Iwabuchi S, Tomiyama A, Samejima H, Ogata N, Goto K
The Second Department of Neurosurgery, Toho University.
Interv Neuroradiol. 1999 Nov;5 Suppl 1:121-6. doi: 10.1177/15910199990050S122. Epub 2001 May 15.
We report scalp arteriovenous fistulas (AVFs) in which we performed embolization and examine the treatment method. The subjects were four cases of scalp AVF treated by embolization. All cases were male and three had a past history of scalp injury. As the feeding artery, we found a single artery in one case and multiple arteries in three cases. In three cases we employed a transarterial approach by cutting down the scalp and embolized the fistula with NBCA (N-butyl-cyanoacrylate). We conducted the embolization procedure as follows in order to securely occlude the fistula; 1) we obtained the precise location of fistula by the superselective angiography; 2) we induced the tip of microcatheter to immediately in front of fistula; 3) when high flow shunt was manifested, we controlled the flow by retaining the balloon catheter in the external carotid artery; 4) and injected NBCA by compressing around the fistula from above the scalp with a cylindrical instrument to prevent the migration of embolic material to the venous side. As a result, all cases were completely cured and there was no major complication except for transient postoperative pain. If the transfemoral approach to fistula is impossible, it is considered effective to cut down near the fistula and embolize the scalp AVF by direct puncture to the feeding artery with NBCA as embolic material.
我们报告了经栓塞治疗的头皮动静脉瘘（AVF）并探讨了治疗方法。研究对象为4例接受栓塞治疗的头皮AVF患者。所有病例均为男性，其中3例有头皮损伤史。作为供血动脉，1例为单支动脉，3例为多支动脉。3例采用经动脉入路，切开头皮，用NBCA（N-丁基-氰基丙烯酸酯）栓塞瘘口。为确保闭塞瘘口，栓塞操作如下：1）通过超选择性血管造影精确确定瘘口位置；2）将微导管尖端置于瘘口前方；3）出现高流量分流时，通过将球囊导管留置在颈外动脉控制血流；4）用柱状器械从头皮上方压迫瘘口周围注入NBCA，防止栓塞材料向静脉侧迁移。结果，所有病例均完全治愈，除术后短暂疼痛外无严重并发症。如果无法经股动脉途径处理瘘口，在瘘口附近切开，以NBCA为栓塞材料直接穿刺供血动脉栓塞头皮AVF被认为是有效的。
