1Bhavya Pahwa

1UCMS and GTB Hospital

Introduction(s):

Dural arteriovenous fistulae (dAVF) account for approximately 10-15% of all intracranial arteriovenous abnormalities. DAVF’s carry a significant risk of mortality, particularly in cases of acute hemorrhage, of up to 10%. A small proportion of these dAVF’s are found in the anterior cranial fossa (ACF), of which the rate of hemorrhage can be as high as up to 91%.  The Scepter Mini (SM) is the smallest dual-lumen balloon available for neurointerventional practice. It consists of a 2.8 French outer diameter, with a 2.2 mm x 9 mm semi-compliant balloon providing a working length of 165 cm. The SM is navigated with a 0.008-inch wire making it a particularly attractive tool accessible to the pedicles normally reached with liquid embolization microcatheters.

Material(s) and Method(s):

Five consecutive patients over a one year period between 2020 and 2021 were evaluated and treated for ACF dAVF using a liquid embolization approach using the SM balloon.  All patients were treated using Ethylene-vinyl-alcohol copolymer (EVOH), of which Squid 18 and/or Squid 12 were the chosen viscosities. Control angiograms were performed for all patients post-embolization.

Result(s):

All patients demonstrated complete occlusion of the ACF dAVF on immediate post treatment angiography. No immediate complications were encountered, particularly there were no reports of visual field deficit in any of the patients.

Conclusion(s):

The SM is a valuable adjunctive tool that can enhance the safety and efficacy of trans-ophthalmic embolization of ACF dAVF’s, providing additional protection to the retinal and posterior ciliary arteries against unwanted reflux of liquid embolic agent.