Griffin Andrew S, Befera Nicholas, Hauck Erik
1 Department of Radiology, Duke University Medical Center, Durham, NC, USA.
2 Department of Neurosurgery, Duke University Medical Center, Durham, NC, USA.
Interv Neuroradiol. 2018 Dec;24(6):702-705. doi: 10.1177/1591019918781670. Epub 2018 Jun 19.
Pial arteriovenous fistulas (AVFs) of the brain are treacherous lesions that can be challenging to treat because of high risk of hemorrhage. We report on a rare case of a pial AVF with a giant venous varix as a draining vein treated successfully with flow-directed balloon-assisted Onyx embolization.
A 56-year-old female with headaches underwent brain magnetic resonance imaging, which demonstrated a 4 cm aneurysmal malformation in the right temporal lobe. A diagnostic cerebral angiogram demonstrated a right temporal pial AVF fed by an enlarged right posterior cerebral artery with drainage into a giant venous varix. Onyx embolization was curative using a flow-directed Scepter balloon catheter.
Flow-directed balloon-assisted Onyx embolization can be highly successful for the curative embolization of pial AVFs. Balloon application changes the nature of the lesion from high-flow-high risk to no-flow-low-risk. Using a flow-directed technique with balloon microcatheters may help minimize the risk of intracranial vascular injury.
脑软膜动静脉瘘（AVF）是一种危险的病变，因其出血风险高，治疗具有挑战性。我们报告一例罕见的软膜AVF病例，其引流静脉为巨大静脉瘤样扩张，采用血流导向球囊辅助Onyx栓塞术成功治疗。
一名56岁头痛女性接受脑部磁共振成像检查，显示右侧颞叶有一个4厘米的动脉瘤样畸形。诊断性脑血管造影显示右侧颞叶软膜AVF，由增粗的右侧大脑后动脉供血，引流至一个巨大静脉瘤样扩张。使用血流导向的Scepter球囊导管进行Onyx栓塞术治愈了该病变。
血流导向球囊辅助Onyx栓塞术对于软膜AVF的根治性栓塞可能非常成功。球囊的应用将病变的性质从高流量高风险转变为无流量低风险。使用带有球囊微导管的血流导向技术可能有助于将颅内血管损伤的风险降至最低。
