title: Flow control using Scepter™ balloons for Onyx embolization of a vein of Galen aneurysmal malformation.
abstract: OBJECTIVE
  We present a technical development of the endovascular treatment technique for vein of Galen aneurysmal malformation, using Onyx™ (ethylene vinyl alcohol copolymer) delivered under flow control through double-lumen balloon microcatheters.
  
  
  METHODS
  An 11-month-old patient that initially presented with increasing head circumference was diagnosed with mural type vein of Galen aneurysmal malformation. Complete cure was obtained in a single endovascular treatment session. Onyx was delivered simultaneously through two double-lumen balloon microcatheters (Scepter™, Microvention, Terumo Group). In both arterial feeders, balloon inflation occluded the high-flow arterial-venous shunting and thus facilitated the controlled propagation of the embolic product in the afferent artery and the shunt point while preventing distal migration into the venous system.
  
  
  RESULTS
  Two years post-procedure, MR imaging showed persistent occlusion of arterial-venous shunts with complete regression of the venous dilatation. On clinical examination, the patient had no neurological deficits, and no cognitive impairment was detected at neuropsychological testing.
  
  
  CONCLUSIONS
  The use of double-lumen balloon microcatheters for flow control during delivery of Onyx represents a viable alternative for the endovascular treatment of vein of Galen aneurysmal malformations.
authors.affiliation: Interventional Neuroradiology Department, Hôpitaux Universitaires de Strasbourg, Strasbourg, France, pop.raoul@gmail.com.
authors.forename: Raoul
authors.initials: R
authors.lastname: Pop
authors.forename: Monica
authors.initials: M
authors.lastname: Manisor
authors.forename: Valérie
authors.initials: V
authors.lastname: Wolff
authors.forename: Pierre
authors.initials: P
authors.lastname: Kehrli
authors.forename: Christian
authors.initials: C
authors.lastname: Marescaux
authors.forename: Rémy
authors.initials: R
authors.lastname: Beaujeux
mesh_terms: D004621:Embolization, Therapeutic / Q000379:methods*; D006801:Humans; D007223:Infant; D018810:Magnetic Resonance Angiography; D008279:Magnetic Resonance Imaging; D008297:Male; D011145:Polyvinyls / Q000627:therapeutic use*; D016896:Treatment Outcome; D054080:Vein of Galen Malformations / Q000601:surgery*; D014711:Vertebral Artery / Q000473:pathology
chemical_list: D011145:Polyvinyls; C020320:ethylene-vinyl alcohol copolymer