• Jonathon Lebovitz, Christopher Storey, Ahmad Sweid, Stavropoula Tjoumakaris, M Reid Gooch, Robert Rosenwasser, and Pascal Jabbour.
• Department of Neurosurgery, Thomas Jefferson University and Jefferson Hospital for Neuroscience, Philadelphia, Pennsylvania, USA.
• World Neurosurg. 2020 Feb 1; 134: 62-66.

BackgroundSpinal arteriovenous fistulas (AVFs) are a rare entity that can have devastating neurologic outcomes. Currently, these lesions are treated via open microsurgical resection or transarterial embolization with good success. However, some patients cannot be treated with a minimally invasive endovascular technique secondary to difficulty catheterizing their vascular anatomy. Our aim is to present a case of balloon-assisted Onyx embolization of a spinal AVF.Case DescriptionWe present the case of a 59-year-old male with progressive lower back pain with lower-extremity weakness. We performed a spinal angiogram where an AVF was identified with very torturous anatomy. The patient was originally treated with open microsurgical resection; however, ≈6 weeks later the fistula and symptoms returned. At that time, we were able to treat the lesion with the Scepter-C balloon.ConclusionsWe present a challenging case in which normal embolization microcatheters were unable to navigate difficult anatomy, but we were able to gain access and obliterate the fistula by using a balloon catheter.Copyright © 2019 Elsevier Inc. All rights reserved.

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