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. 2022;16(1):56-62.
doi: 10.5797/jnet.tn.2020-0175. Epub 2021 Apr 24.

A Case of Scalp Arteriovenous Malformation Treated by Transvenous Embolization Using Onyx

Shun Takano  1 , Hiroo Yamaga  2 , Akihiro Sakaguchi  1 , Akira Nishiyama  1 , Hajime Yabuzaki  1 , Yuko Tanaka  1 , Yoshikazu Matsuda  1 , Tomoyuki Tsumoto  1 , Akihiro Matsumoto  1 , Tomoaki Terada  1
Affiliations

A Case of Scalp Arteriovenous Malformation Treated by Transvenous Embolization Using Onyx

Shun Takano et al. J Neuroendovasc Ther. 2022.

Abstract

Objective: We treated a case of scalp arteriovenous malformation (sAVM) by transvenous embolization using Onyx.

Case presentation: We describe the case of a 17-year-old woman with a pulsatile mass at the right temporal area. DSA identified sAVM with the venous pouch between the right occipital artery (OA) and the right two occipital veins (OVs), which was also fed by multiple branches of the right posterior auricular artery (PAA) and superficial temporal artery (STA). The shunts were completely occluded by the reverse pressure cooker technique (RPCT), which involves navigating the balloon catheters just distal to the shunt point in the OVs approaching from the right external jugular vein (EJV) and injecting Onyx to each feeder retrogradely with balloons inflated.

Conclusion: This technique may be useful for treating sAVM with venous angioarchitecture enabling a transvenous approach.

Keywords: Onyx; scalp arteriovenous malformation; transvenous embolization.

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Conflict of interest statement

The authors declare no conflict of interest.

Figures

Fig. 1
Fig. 1. The clinical photo (A) shows a 30-mm pulsatile mass behind the right ear with bruit at night. There was no redness or tenderness. CTA (B) shows abnormal angioarchitecture, suggesting sAVM. sAVM: scalp arteriovenous malformation
Fig. 2
Fig. 2. Lateral DSA of the right external carotid artery in the early (A), capillary (B), and late (C) phases shows sAVM supplied from mainly the OA (A, white arrow) and the PAA (A, white arrowhead), the STA (A, black arrow), and through the venous pouch (B, white arrow), draining to the two OVs (C, white arrows) connecting to the EJV (C, asterisk). The two inflated Scepter C balloons in the OVs (D, white arrows) placed just distal to the venous pouch prevented the migration of the Onyx into the pulmonary artery and helped to pull out the Onyx into each feeder retrogradely. External carotid angiography with the inflated Scepter C balloons shows flow interruption of the OVs (E, white arrows) except the minor outflow veins (E, black arrow) to the EJV. EJV: external jugular vein; OA: occipital artery; OVs: occipital veins; PAA: posterior auricular artery; sAVM: scalp arteriovenous malformation; STA: superficial temporal artery
Fig. 3
Fig. 3. Schematic diagram of the sAVM. sAVM: scalp arteriovenous malformation
Fig. 4
Fig. 4. Onyx 34 was injected through the inflated Scepter into the venous pouch (A), and entered into the OA and the STA retrogradely (B). Onyx 18 passed through the venous pouch and entered into the distal portion of the OA, STA, and PAA (C). DSA of the right external carotid artery after injecting Onyx shows complete occlusion of the AVM (D) and injected Onyx (E). AVM: arteriovenous malformation; OA: occipital artery; PAA: posterior auricular artery; STA: superficial temporal artery
Fig. 5
Fig. 5. Angiographic examination at 6 months after embolization confirms no sign of arteriovenous malformation (A) and shows the Onyx mass (B).
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