title: Endovascular treatment for traumatic scalp arteriovenous fistulas: results with Onyx embolization.
abstract: BACKGROUND
  Arteriovenous fistulas of the scalp (S-AVFs) are rare lesions and may occur spontaneously or secondary to trauma. The use of Onyx for the treatment of S-AVFs is not well established at this time. We discuss three cases of traumatic S-AVFs treated successfully with Onyx embolization alone or in association with coils.
  
  
  METHODS
  The database of patients treated at the Baptist Cardiac and Vascular Institute, Miami, Florida, was reviewed. All patients with traumatic S-AVFs treated with Onyx were included.
  
  
  RESULTS
  Two men and one woman with progressive enlarging pulsatile mass with bruit or tinnitus had angiographic evidence of S-AVF and were treated. In two patients the S-AVFs were secondary to hair transplantation. They were treated with Onyx-18 embolization as the single treatment modality. One patient with S-AVF resulting from temporomandibular joint arthroscopy was treated with coils and subsequent Onyx-34 embolization. In one patient, transarterial microcatheterization and injection of Onyx-18 was performed. In another patient, the intra-arterial approach was prevented by arterial vessel tortuosity. Therefore, access to the fistula was obtained through direct puncture of a large frontal vein; contrast injection confirmed the positioning of the needle within the draining vein of the AVF and Onyx-18 was then injected while the outflow vein was compressed. In the third patient in this series, coils were deployed to allow safer and more controlled injection of Onyx-34. No procedure related complications were noted. Post-embolization angiography demonstrated successful and complete occlusion of the AVF immediately after treatment. Follow-up revealed complete resolution of the symptoms.
  
  
  CONCLUSIONS
  Our experience in this small series indicates that endovascular treatment of S-AVFs with Onyx is rapid, safe, and highly effective.
authors.affiliation: Division of NeuroInterventional Surgery, Baptist Cardiac and Vascular Institute and Baptist Neuroscience Center, Miami, Florida, USA.
authors.forename: Guilherme
authors.initials: G
authors.lastname: Dabus
authors.forename: Raffaella
authors.initials: R
authors.lastname: Pizzolato
authors.forename: Eugene
authors.initials: E
authors.lastname: Lin
authors.forename: Andreas
authors.initials: A
authors.lastname: Kreusch
authors.forename: Italo
authors.initials: I
authors.lastname: Linfante
mesh_terms: D000328:Adult; D001164:Arteriovenous Fistula / Q000000981:diagnostic imaging / Q000209:etiology / Q000628:therapy*; D001182:Arthroscopy / Q000009:adverse effects; D057785:Catheters; D003357:Cosmetic Techniques / Q000009:adverse effects; D004338:Drug Combinations; D004621:Embolization, Therapeutic / Q000295:instrumentation / Q000379:methods*; D005260:Female; D006197:Hair / Q000637:transplantation; D006801:Humans; D008297:Male; D008875:Middle Aged; D011145:Polyvinyls / Q000627:therapeutic use*; D011859:Radiography; D012535:Scalp / Q000098:blood supply* / Q000000981:diagnostic imaging / Q000293:injuries*; D013635:Tantalum / Q000627:therapeutic use*; D013812:Therapeutics
chemical_list: D004338:Drug Combinations; C558446:Onyx 18; D011145:Polyvinyls; D013635:Tantalum
keywords: Arteriovenous Malformation; Embolic; Fistula; Intervention; Liquid Embolic Material