Neurointervention.  2023 Mar;18(1):67-71. 10.5469/neuroint.2022.00465.

Direct Puncture of the Superficial Temporal Artery in Embolization of a Scalp Arteriovenous Fistula: A Case Report

• Walker GB
• Wang AP
• Hadwen J
• Erdenebold UE
• Bebedjian R
• Sullivan P
• Santos MP
• Chenier C
• Karwaski S
• Caron K
• Varga G
• Lyon J
• Lesiuk HJ
• Heran N
• Heran M
• Quateen A
• Drake BJ
• Oliveira EPD
• Kontolemos M
• Fahed R

• KMID: 2539949
• DOI: http://doi.org/10.5469/neuroint.2022.00465

Abstract

We describe a minimally invasive endovascular approach to treat an arteriovenous fistula of the scalp. We performed a direct puncture of the lesion through the patient’s scalp for liquid embolic agent injection along with external compression of the superficial temporal artery to perform a “manual pressure-cooker technique.” The combination of these minimally invasive techniques resulted in an excellent clinical and radiographic outcome.

Keyword

Arteriovenous fistula; Endovascular procedures; Punctures; Embolization, therapeutic

Figure

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  Fig. 1. Brain CTA in coronal view (A) shows enlarged vessels in the right scalp area (arrow), fed by the right superficial temporal artery as seen on 3D reconstruction (B). The angiogram (C, D) confirms the presence of an enlarged superficial temporal artery feeding an arteriovenous fistula with a large venous pouch and several enlarged veins, with eventual drainage into the superior sagittal sinus (E). (F) The Apollo catheter is inserted into the check flow valve using the tip of the Terumo wire housing as an introducer (arrow). The valve is attached to the Angiocath cannula from the thin wall entry needle, and together these act as a sheath directly placed inside the scalp lesion. Using this setup, we were able to inject liquid embolic agent directly into the nidus with no arterial reflux thanks to manual external compression of the feeding superficial temporal artery. (G) The patient’s symptoms fully resolved immediately after the procedure. (H, I) The 6-month follow-up angiogram confirmed the complete obliteration of the lesion (arrow).

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