Balloon-assisted superselective microcatheterization for transarterial treatment of cranial dural arteriovenous fistulas:  technique and results.
BACKGROUND
In transarterial embolization of anterior cranial fossa and tentorial dural arteriovenous fistula (DAVF), acute angulation of the feeding artery off the internal carotid artery (ICA) may render stable distal catheterization and, therefore, successful transarterial treatment difficult. In some anatomic dispositions, following selection of the feeding artery, subsequent forward force may lead to prolapse of the microcatheter into the ICA rather than advancing it into either the ophthalmic artery or the meningohypophyseal trunk.


OBJECTIVE
We describe a technique that facilitates stable positioning of the microcatheter by using a nondetachable balloon to temporally block the ICA distal to the feeding artery to redirect the catheter into the feeder and to prevent the microcatheter from protruding into the parent artery.


METHODS
In 8 cases where routine superselective microcatheterization failed, a balloon was used to block the ICA distal to the feeding artery in an attempt to facilitate superselective microcatheterization. The balloon was inflated following selection of the feeding vessel with the microcatheter and was kept inflated while advancing the catheter.


RESULTS
: Distal stable microcatheter positions could be obtained in all cases, which enabled us to treat the respective DAVFs with a liquid embolic agent. All 8 cases were angiographically cured with penetration of the liquid embolic agent from the distal artery to the proximal vein, and no procedure-related complications occurred.


CONCLUSIONS
The described technique may be a helpful adjunct to gain stable distal microcatheter positions during the transarterial treatment of DAVF.
Department of Neurosurgery, Changhai Hospital, Second Military Medical University, 168 Changhai Road, Shanghai, China.
Wen-Yuan
WY
Zhao
Timo
T
Krings
Peng-Fei
PF
Yang
Jian-Min
JM
Liu
Yi
Y
Xu
Qiang
Q
Li
Yi-Bin
YB
Fang
Qing-Hai
QH
Huang
Yong-Fa
YF
Wu
D000328:Adult; D000368:Aged; D021721:Balloon Occlusion / Q000379:methods*; D002404:Catheterization; D020785:Central Nervous System Vascular Malformations / Q000601:surgery*; D004621:Embolization, Therapeutic / Q000379:methods*; D006801:Humans; D008297:Male; D008866:Microsurgery; D008875:Middle Aged; D019635:Neurosurgical Procedures / Q000379:methods*