Intracranial dural arteriovenous fistulas (dAVFs) may be difficult to treat by endovascular means, especially when the arterial feeders to the fistula are tortuous. 1 The usual main feeder to intracranial dAVFs is the middle meningeal artery, which may present very tight loops that are often difficult to cross with a microcatheter. 2 Direct puncture of a subcutaneous artery feeding the fistula indirectly via transosseous branches may be a valuable strategic option to overcome this limitation. 3 4 We report here the successful embolization of a Cognard type 3 parietal dAVF by direct puncture of the superficial temporal artery under roadmap guidance. The dAVF was subsequently embolized with ethylene vinyl alcohol via a dual lumen balloon, under balloon inflation. We highlight in this technical video 1 the potential difficulties and risks of direct puncture of the superficial temporal artery. We also stress the risk of delayed scalp necrosis using this technique.
- vascular malformation
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Contributors FC: data collection, manuscript writing, and video preparation. ES, AP, and SM: data collection and critical review of the manuscript. SL, KP, PC, and N-AS: critical review of the manuscript.
Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial, or not-for-profit sectors.
Competing interests FC reports conflicts of interest with Medtronic, Guerbet, Balt Extrusion, Penumbra (payment for readings; not related to the study), Codman Neurovascular, and Microvention (core lab; not related to the study). N-AS is a consultant for Medtronic, Balt Extrusion, and Microvention.
Provenance and peer review Not commissioned; externally peer reviewed.