Neurointervention.  2024 Nov;19(3):169-173. 10.5469/neuroint.2024.00374.

Endovascular Treatment of Scalp Arteriovenous Fistula: Transvenous Onyx Embolization with Balloon Occlusion

• Kim T
• Suh SH

• KMID: 2560221
• DOI: http://doi.org/10.5469/neuroint.2024.00374

Abstract

Scalp arteriovenous fistulas (AVFs) are rare vascular anomalies characterized by abnormal connections between arterial and venous systems in the scalp. These lesions can lead to significant complications, including chronic headaches, tinnitus, cosmetic deformities, and in severe cases, high-output cardiac failure or intracranial hemorrhage. We present a case of a middle-aged female patient with a 20-year history of a pulsating mass on the left parietal scalp. Magnetic resonance imaging and cerebral angiography confirmed the presence of a scalp AVF with multiple arterial feeders from the external carotid artery and venous drainage into the left external jugular vein. Due to the tortuosity of the feeding arteries, a transarterial approach was unsuccessful, leading to the decision to perform transvenous embolization with balloon occlusion using Onyx-18. The procedure resulted in complete obliteration of the AVF without complications. This case highlights the efficacy of transvenous embolization with balloon occlusion as a treatment option for complex scalp AVFs, particularly when transarterial access is challenging.

Keyword

Scalp; Arteriovenous fistula; Embolization; Balloon occlusion; Veins

Figure

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  Fig. 1. Cerebral angiography (A–F) shows a detailed angioarchitecture of the scalp arteriovenous fistula (AVF) with feeding arteries from the left external carotid artery, such as the occipital artery, middle meningeal artery, superficial temporal artery, supraorbital artery (C, white arrow), and left vertebral artery anastomosis (F, white arrow). The main venous drainage was the left superficial temporal vein (STV) (A and D, black arrow). The roadmap image (G) shows balloon occlusion in the distal STV. The scalp vascular lesion was filled with Onyx casting during balloon occlusion (black arrow, H), and control angiography of the left common carotid artery shows complete obliteration of the scalp AVF (I).

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