Embolization of scalp AVF

We report scalp arteriovenous fistulas (AVFs) in which we performed embolization and examine the treatment method. The subjects were four cases of scalp AVF treated by embolization. All cases were male and three had a past history of scalp injury. As the feeding artery, we found a single artery in one case and multiple arteries in three cases. In three cases we employed a transarterial approach by cutting down the scalp and embolized the fistula with NBCA (N-butyl-cyanoacrylate). We conducted the embolization procedure as follows in order to securely occlude the fistula; 1) we obtained the precise location of fistula by the superselective angiography; 2) we induced the tip of microcatheter to immediately in front of fistula; 3) when high flow shunt was manifested, we controlled the flow by retaining the balloon catheter in the external carotid artery; 4) and injected NBCA by compressing around the fistula from above the scalp with a cylindrical instrument to prevent the migration of embolic material to the venous side. As a result, all cases were completely cured and there was no major complication except for transient postoperative pain. If the transfemoral approach to fistula is impossible, it is considered effective to cut down near the fistula and embolize the scalp AVF by direct puncture to the feeding artery with NBCA as embolic material.