Balloon-Occlusion Catheter Onyx Embolization of a Spinal Dural Arteriovenous Fistula Presenting with Subarachnoid Hemorrhage in a Pediatric Patient Journal Article

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Authors: Hayward, D. M.; Johans, S. J.; Rosenblum, J. D.; Loftus, C. M.; Ashley, W. W.
Article 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. CONCLUSION: 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.
Journal Title: Journal of stroke and cerebrovascular diseases : the official journal of National Stroke Association
Volume: 25
Issue: 4
ISSN: 1532-8511; 1052-3057
Publisher: Unknown  
Journal Place: United States
Date Published: 2016
Start Page: e46
End Page: 9
Language: eng
DOI/URL:

10.1016/j.jstrokecerebrovasdis.2015.12.040
Notes: CI: Copyright (c) 2016; JID: 9111633; OTO: NOTNLM; 2015/01/26 [received]; 2015/11/21 [revised]; 2015/12/30 [accepted]; 2016/02/02 [aheadofprint]; ppublish