title: Balloon-assisted Onyx embolization of cerebral single-channel pial arteriovenous fistulas.
abstract: OBJECTIVE
  Pial arteriovenous fistulas (AVFs) of the brain are rare vascular malformations associated with significant risks of hemorrhage and neurological deficit. Depending on their location and high-flow dynamics, these lesions can present treatment challenges for both endovascular and open cerebrovascular surgeons. The authors describe a novel endovascular treatment strategy that was used successfully to treat 2 pediatric patients with a pial AVF, and they discuss the technical nuances specific to their treatment strategy.
  
  
  METHODS
  A single-channel high-flow pial AVF was diagnosed in 2 male patients (6 and 17 years of age). Both patients were treated with endovascular flow arrest using a highly conformable balloon followed by Onyx infusion for definitive closure of the fistula.
  
  
  RESULTS
  Neither patient suffered a complication as a result of the procedure. At the 6-month follow-up in both cases, the simple discontinuation of blood flow had resulted in durable obliteration of the fistula and stable or improved neurological function.
  
  
  CONCLUSIONS
  Onyx can be delivered successfully into high-flow lesions after flow arrest to allow a minimally invasive and durable treatment for pial AVFs.
authors.affiliation: Division of Neurosurgery, University of California-San Diego, CA, USA.
authors.forename: C Benjamin
authors.initials: CB
authors.lastname: Newman
authors.forename: Yin C
authors.initials: YC
authors.lastname: Hu
authors.forename: Cameron G
authors.initials: CG
authors.lastname: McDougall
authors.forename: Felipe C
authors.initials: FC
authors.lastname: Albuquerque
mesh_terms: D000293:Adolescent; D001164:Arteriovenous Fistula / Q000000981:diagnostic imaging / Q000628:therapy*; D021721:Balloon Occlusion / Q000295:instrumentation / Q000379:methods*; D002648:Child; D004621:Embolization, Therapeutic / Q000295:instrumentation / Q000379:methods*; D005500:Follow-Up Studies; D006801:Humans; D002538:Intracranial Arteriovenous Malformations / Q000000981:diagnostic imaging / Q000628:therapy*; D018810:Magnetic Resonance Angiography; D008297:Male; D010841:Pia Mater / Q000098:blood supply*; D011145:Polyvinyls / Q000008:administration & dosage*; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome
chemical_list: D011145:Polyvinyls; C020320:ethylene-vinyl alcohol copolymer