Endovascular Treatment of Two High-Flow Brain Arteriovenous Fistulas with a Combination of Detachable Coils and Onyx in an Infant: Case Report and Review of Literature

Congenital brain arteriovenous fistulas (BAVFs) are rare neurovascular lesions of the brain, and few cases have been reported of their treatment with a combination of detachable coils and Onyx, especially in infants. Here, we present a case of 2 high-flow BAVFs occurring in a 12-month-old boy. Standard techniques of digital subtraction angiography were used, and dimethyl sulfoxide-compatible microcatheters were delivered and entered into a distal feeding artery as closely as possible to the fistulas. Then, a combination of detachable coils and Onyx was used. After the treatment of the 2 high-flow BAVFs, a complete percutaneous embolization of the fistulas was obtained. The fistulas remained closed, as ascertained by follow-up angiograms. No new neurological deficit related to the procedure was detected, and the infant was asymptomatic and in good health 4 years after the surgery. Our case shows that the endovascular treatment of high-flow BAVFs with a combination of detachable coils and Onyx in an infant is safe and effective. (C) 2015 S. Karger AG, Basel