ArticleJournal of neuroendovascular therapy2026
Stepwise Incisionless Percutaneous Flow-Control Treatment of a High-Flow Scalp Arteriovenous Fistula with a Large Superficial Venous Pouch: A Case Report.
Article in Journal of neuroendovascular therapy, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
Objective: Scalp arteriovenous fistulas (AVFs) with multiple tortuous superficial feeders and a large venous pouch can require meticulous flow control during treatment. Open surgical excision may be associated with blood loss, wound-healing problems, and cosmetic concerns, whereas percutaneous liquid embolization of a high-flow superficial shunt carries a risk of nontarget migration and scalp necrosis. We report an incisionless, stepwise percutaneous flow-control strategy for such a lesion. Case Presentation: A man in his 50s presented with a progressively enlarging, pulsatile right temporal mass, pulsatile tinnitus, and visual fatigue 30 years after head trauma. DSA revealed a high-flow scalp AVF supplied by the right superficial temporal artery (STA), the right occipital artery, and the contralateral STA, draining through a 2.5-cm superficial venous pouch; the lesion corresponded to Cho-Do type II and Yakes type IIb. We performed a stepwise percutaneous intervention. First, we injected epinephrine-containing lidocaine around the pouch to constrict distal feeding arteries. Second, we punctured the primary draining vein and deployed microcoils to establish a mechanical scaffold. Third, under circumferential compression, we sequentially injected 25% and 30% n-butyl cyanoacrylate-Lipiodol (Guerbet, Villepinte, France) mixtures via direct puncture to obliterate the posterior and anterior compartments. Finally, we occluded the residual STA feeder using ultrasound-guided percutaneous suture ligation. The patient experienced no ischemic cutaneous complications. DSA at 12 months confirmed complete AVF obliteration. Conclusion: In selected superficial scalp AVFs, combining pharmacological inflow reduction, direct-puncture coil scaffolding, circumferential compression, and ultrasound-guided percutaneous suture ligation may provide a less invasive alternative to open resection.
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