Newman C Benjamin, Hu Yin C, McDougall Cameron G, Albuquerque Felipe C
Division of Neurosurgery, University of California-San Diego, CA, USA.
J Neurosurg Pediatr. 2011 Jun;7(6):637-42. doi: 10.3171/2011.4.PEDS10577.
Pial arteriovenous fistulas (AVFs) of the brain are rare vascular malformations associated with significant risks of hemorrhage and neurological deficit. Depending on their location and high-flow dynamics, these lesions can present treatment challenges for both endovascular and open cerebrovascular surgeons. The authors describe a novel endovascular treatment strategy that was used successfully to treat 2 pediatric patients with a pial AVF, and they discuss the technical nuances specific to their treatment strategy.
A single-channel high-flow pial AVF was diagnosed in 2 male patients (6 and 17 years of age). Both patients were treated with endovascular flow arrest using a highly conformable balloon followed by Onyx infusion for definitive closure of the fistula.
Neither patient suffered a complication as a result of the procedure. At the 6-month follow-up in both cases, the simple discontinuation of blood flow had resulted in durable obliteration of the fistula and stable or improved neurological function.
Onyx can be delivered successfully into high-flow lesions after flow arrest to allow a minimally invasive and durable treatment for pial AVFs.
脑软膜动静脉瘘（AVF）是一种罕见的血管畸形，伴有显著的出血风险和神经功能缺损。根据其位置和高流量动力学，这些病变对血管内和开放性脑血管外科医生而言均构成治疗挑战。作者描述了一种新型血管内治疗策略，该策略成功用于治疗2例患有软膜AVF的儿科患者，并讨论了其治疗策略特有的技术细节。
2例男性患者（6岁和17岁）被诊断为单通道高流量软膜AVF。两名患者均采用顺应性高的球囊进行血管内血流阻断，随后注入Onyx以最终闭合瘘口。
两名患者均未因该手术出现并发症。在两例患者的6个月随访中，单纯血流中断已导致瘘口持久闭塞，神经功能稳定或改善。
在血流阻断后，Onyx可以成功输送至高流量病变部位，从而为软膜AVF提供微创且持久的治疗。
