• Masashi Kotsugi, Ichiro Nakagawa, Yoshiaki Takamura, Takeshi Wada, Kimihiko Kichikawa, and Hiroyuki Nakase.
• Department of Neurosurgery, Nara Medical University, Nara, Japan.
• World Neurosurg. 2019 Oct 1; 130: 227-230.

BackgroundTransarterial embolization (TAE) using liquid embolic material is a standard treatment for non-sinus-type dural arteriovenous fistula (DAVF). However, to reach embolic material over a shunt point for complete obliteration of DAVF is often difficult. We present a technical case report of the efficacy of bilateral external carotid artery (ECA) flow control for the TAE of superior sagittal sinus DAVF.Case DescriptionA 64-year-old man presented with dizziness and left hemiparesis. Computed tomography imaging showed right parietal subcortical hemorrhage, and cerebral angiography revealed a DAVF in the superior sagittal sinus fed by bilateral occipital artery, bilateral superficial temporal artery and bilateral middle meningeal artery (MMA), with cortical venous reflux and without connection to the superior sagittal sinus. We therefore planned TAE using glue via MMA under bilateral ECA flow control. A 7-Fr balloon guide catheter was positioned in the bilateral ECA origins, and a microcatheter was introduced distal to the MMA. Heated 20% n-butyl-2-cyanoacrylate was slowly injected via the left MMA under bilateral ECA origin flow control. The n-butyl-2-cyanoacrylate reached the shunt point and obliterated the shunt in a single session. The patient was discharged without neurological symptoms.ConclusionsBilateral ECA flow control using balloon guide catheter is safe and effective for a DAVF in the superior sagittal sinus with multiple and tortuous scalp feeders.Copyright © 2019 Elsevier Inc. All rights reserved.

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