Scepter Mini for the Treatment of an Anterior Ethmoidal Artery Dural Arteriovenous Fistula: Technical Case Report

Abstract

Background: Dural arteriovenous fistulas of the anterior skull base pose a particular challenge for interventionalists; thus, these lesions have historically been addressed surgically. The Scepter Mini dual-lumen balloon microcatheter is the smallest dual-lumen liquid embolic compatible catheter on the market and has the potential to revolutionize the treatment of these lesions.  We present the treatment and cure of an anterior cranial fossa dural arteriovenous fistula treated trans-arterially through the ophthalmic artery using the Scepter mini microcatheter.  

Methods: A 77-year-old male was incidentally found to have an anterior cranial fossa dural arteriovenous fistula fed by bilateral anterior ethmoidal arteries. Primary drainage was via a subfrontal cortical vein draining into a sylvian vein and then into the right Vein of Labbe. The patient underwent transarterial embolization of the dural arteriovenous fistula via the right ophthalmic artery with Onyx 18 via the Scepter Mini dual-lumen balloon microcatheter.

Results: The fistula was angiographically cured, and the proximal ophthalmic artery and central retinal artery were preserved. The patient was intact after the procedure and at follow up. 

Conclusion: Anterior cranial fossa dural arteriovenous fistulas were classically thought to be surgical lesions due to the challenging endovascular anatomy; however, the Scepter Mini allows for safe access of distal vasculature and immediate flow arrest for optimal safe delivery of liquid embolic agents. This case, along with others, suggest the remarkable value of this new dual-lumen balloon microcatheter.