Percutaneous transosseous embolization of a diploic vein arteriovenous fistula with intracranial and extracranial shunting

Abstract

Arteriovenous fistulae of the diploic veins are extremely rare. 1 Transarterial- and transvenous embolization have been employed in endovascular treatment. 2 – 7 We describe a novel treatment technique in which percutaneous transosseous embolization was performed to treat an extensive diploic vein arteriovenous fistula in the sphenoid bone with a 5 -cm venous varix. Numerous branches of the internal and external carotids fed the fistula with extracranial and intracranial shunting including cortical venous reflux. Safe transarterial embolization was inadequate. Transvenous access into the diploic venous varix through emissary veins was not successful. An 18-G needle was used under fluoroscopy to access the venous varix through the thinned outer table of the sphenoid greater wing. Brainlab navigation system was used to pre-study needle's insertion point and trajectory. Uneventful coil and Onyx embolization was performed. Educational message Transosseous embolization of diploic vein arteriovenous fistula is feasible when necessary in select cases.