Article Text

Download PDFPDF
Case series
Use of a mini balloon microcatheter to facilitate penetration of fine vascular networks and curative embolization in vein of Galen malformations
  1. Alex Devarajan,
  2. Alexander J Schupper,
  3. Christina P Rossitto,
  4. Jessica M Bonet,
  5. Michelle Sorscher,
  6. Vikram Vasan,
  7. Peter F Morgenstern,
  8. Saadi Ghatan,
  9. Tomoyoshi Shigematsu,
  10. Alejandro Berenstein,
  11. Johanna T Fifi
  1. Neurosurgery, Icahn School of Medicine at Mount Sinai, New York City, New York, USA
  1. Correspondence to Alex Devarajan, Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA; alex.devarajan{at}


Background Patients with vein of Galen malformations (VOGMs) can develop fine angiogenic networks with fistulous connections to the precursor of the vein of Galen. In these cases, transarterial embolization (TAE) with liquid embolic agents (LEAs) is challenging due to reflux in the pedicle leading to the network, causing poor penetration. Transvenous approaches carry a risk of hemorrhage from pathologic vasculature. Dual-lumen balloon microcatheters like the Scepter Mini (Microvention, Aliso Viejo, CA) improve distal pedicle access, preventing reflux.

Objective Here, we report on the use of the Scepter Mini for TAE of angiogenic VOGM.

Methods A single-institution retrospective chart review identified all VOGMs treated with Scepter Mini microcatheters. Clinical data, angioarchitecture, and technical parameters were reviewed.

Results 17 Scepter Mini catheters were used in 12 embolization procedures of 7 patients with VOGM at a median age of 2.1 years. Patients presented with hydrocephalus (100%) and gross motor and speech delays (57.1%). Networks developed extra-axially into the subependymal zone fed by posterior choroidal, posterior cerebral, and thalamoperforator arteries. Posterior choroidal branches (n=7/17, 41.2%) were most frequently catheterized to achieve distal access to the network. Embolization with Onyx-18 and significant network penetration occurred in 17/17 uses. Near tip entrapment with LEA cast displacement occurred in 1/17 uses. Another patient experienced postprocedural intraventricular hemorrhage requiring a third ventriculostomy without permanent neurologic deficit.

Conclusion The Scepter Mini provided excellent distal access with penetration to the fistula and extra-axial network reduction with few complications. The Scepter Mini provides a means for successful treatment of technically challenging angiogenic VOGM.

  • Pediatrics
  • Arteriovenous Malformation
  • Catheter
  • Angiography
  • Liquid Embolic Material

Statistics from

Request Permissions

If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.


  • X @AlexDevarajan, @cprossitto

  • Presented at This abstract has been accepted as a poster at the Society of NeuroInterventional Surgery’s 20th Annual Meeting in San Diego, CA from July 31-August 3, 2023.

  • Contributors Conceptualization: AD, TS, AB, JTF. Methodology: AD, AB, JTF. Data curation: AD, CPR, VV, JMB, MS. Formal data analysis and investigation: AD. Original draft preparation: AD, AJS. Review and editing of the manuscript: AD, AJS, CPR, JMB, MS, VV, PFM, SG, TS, AB, JTF. Project supervision: TS, AB, JTF.

  • 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 AB and JTF are consultants for Microvention. JTF is a member of the SNIS Board of Directors.

  • Provenance and peer review Not commissioned; externally peer reviewed.