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

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.

Surgical Treatment of Spontaneous Superficial Temporal Artery Arteriovenous Malformation: A Case Report

“…Yagi et al recognized that many cases were associated with a history of hypertension or disease processes related to hypertension [ 4 ]. Walker et al hypothesized that radiation may be a cause [ 13 ]. Our patient presented with a spontaneous AVM of STA without any history of trauma or recent manipulation, and she had no documented diagnosis of hypertension.…”

“…Disadvantages to surgical excision include possibility of undesirable cosmesis at the incision site in addition to a higher chance of increased blood loss compared to other methods [ 12 , 13 ]. Ligation alone of the feeding artery and draining vein has been reported [ 12 ].…”

“…Endovascular therapy via transarterial, transvenous, and percutaneous access has been reported [ 1 , 21 ]. Walker et al describes a direct puncture technique that avoids navigating a catheter and guidewires, decreases operative time, decreases radiation exposure, decreases contrast load, and provides increased delivery of the chemical agent to the targeted area for embolization [ 13 ]. Access via carotid or femoral carries significant risks.…”

“…Kominami et al described embolization utilizing glue, without recurrence [ 24 ]. Glue agents include N-butyl-2-cyanoacrylate (NBCA) [ 13 ]. Liquid embolic agents include Onyx, ethylene vinyl alcohol copolymer (SQUID), and hydrophobic injectable liquid (PHIL).…”

Hybrid Endovascular and Surgical Treatment of a Traumatic Scalp Arteriovenous Fistula

“…Direct puncture embolization using sclerosing agents such as n-butyl cyanoacrylate (NBCA) has also been reported, offering the advantage of bypassing the arterial feeders. This approach results in a faster procedure with reduced radiation and contrast exposure [ 11 ]. However, a dilated venous pouch and complete control of inflow and outflow are required to ensure effective occlusion and prevent distal migration of the embolic agents into the pulmonary circulation [ 5 , 12 ].…”