title: Balloon-Occlusion Catheter Onyx Embolization of a Spinal Dural Arteriovenous Fistula Presenting with Subarachnoid Hemorrhage in a Pediatric Patient.
abstract: OBJECTIVE
  Spinal dural arteriovenous fistulas (DAVFs) are insidious pathologies that, if left untreated, harbor potentially devastating consequences to the central nervous system. Spinal DAVFs are rare in the adult population and exceedingly uncommon in the pediatric population. In this report, we describe a spinal DAVF in a 3-year-old child whose initial presentation is subarachnoid hemorrhage (SAH). Balloon-test occlusion and balloon-catheter-assisted embolization of DAVF have not been previously described, and their advantages over alternative embolic and surgical techniques are discussed.
  
  
  METHODS
  We performed a literature search on MEDLINE/PubMed to review current reports describing the epidemiology, clinical presentation, and treatment of spinal DAVFs. In this report, we describe a spinal DAVF in a 3-year-old child whose initial presentation is SAH.
  
  
  RESULTS
  A spinal DAVF was diagnosed after deciding to image not only the brain but also the spine. Using a balloon-occlusion catheter, we confirmed that the DAVF arterial feeding vessel could be safely embolized. We then proceeded to effectively treat the DAVF with balloon-catheter-assisted Onyx-18 embolization.
  
  
  CONCLUSIONS
  Based on our report and an analysis of the literature, we propose that pediatric patients presenting with nontraumatic SAH should undergo at least a magnetic resonance imaging of the brain and cervical spine as part of their initial workup. In addition, we describe a balloon-occlusion catheter embolization technique that allows not only excellent embolic penetration of the fistula but also prevention of microcatheter reflux and lessening of the need for a tedious plug-and-stack technique.
authors: Department of Neurological Surgery, Loyola University Medical Center, Maywood, Illinois. Electronic address: dhayward315@gmail.com.
authors: Dustin M
authors: DM
authors: Hayward
authors: Department of Neurological Surgery, Loyola University Medical Center, Maywood, Illinois.
authors: Stephen J
authors: SJ
authors: Johans
authors: Department of Neurological Surgery, Loyola University Medical Center, Maywood, Illinois.
authors: Jordan D
authors: JD
authors: Rosenblum
authors: Department of Neurological Surgery, Loyola University Medical Center, Maywood, Illinois.
authors: Christopher M
authors: CM
authors: Loftus
authors: Department of Neurological Surgery, Loyola University Medical Center, Maywood, Illinois.
authors: William W
authors: WW
authors: Ashley
mesh_terms: D021721:Balloon Occlusion / Q000379:methods*; D020785:Central Nervous System Vascular Malformations / Q000150:complications / Q000000981:diagnostic imaging / Q000628:therapy*; D002675:Child, Preschool; D004338:Drug Combinations; D005260:Female; D006801:Humans; D007091:Image Processing, Computer-Assisted; D008279:Magnetic Resonance Imaging; D011145:Polyvinyls / Q000627:therapeutic use*; D013116:Spinal Cord / Q000000981:diagnostic imaging; D013345:Subarachnoid Hemorrhage / Q000150:complications / Q000000981:diagnostic imaging / Q000628:therapy*; D013635:Tantalum / Q000627:therapeutic use*
chemical_list: D004338:Drug Combinations; C558446:Onyx 18; D011145:Polyvinyls; D013635:Tantalum
keywords: Onyx embolization; Spinal dural arteriovenous fistula; balloon-occlusion catheter; pediatric subarachniod hemorrhage