Utilisation of the Scepter Mini dual-lumen balloon - An illustrative series.

BACKGROUND: Dual-lumen balloon microcatheters can aid in the safety and efficacy of endovascular embolisation of cerebrospinal vascular malformations. The Scepter Mini dual-lumen balloon is a novel device with a smaller profile than previous balloon microcatheters, opening up new indications not only in the treatment of cerebrospinal malformations but in various other neurovascular therapeutic and diagnostic scenarios. METHODS: Following institutional ethics review board approval, a retrospective review of our prospectively maintained database of cases employing the Scepter Mini dual-lumen microballoon catheter was conducted. Five cases in particular were highlighted, demonstrating utilisation of this device, which may be of interest to the Neurointerventionalist. Patient demographics, procedure details, complications and clinical outcome data were reviewed. RESULTS: Five cases employing the Scepter Mini dual-lumen microballoon catheter are presented; trans-arterial embolisation of cerebral AVM, pre-operative tumour embolisation, diagnostic angiography, trans-venous embolisation of cerebral AVM and trans-arterial embolisation of DAVF. No intraprocedural complications were recorded, one patient had a delayed haemorrhage. CONCLUSION: Potential utilisation of the Scepter Mini lies not only in the trans-arterial embolisation of cerebrospinal vascular malformations, but in a range of other diagnostic and therapeutic indications as demonstrated.

Recognition of the variant type of spinal dural arteriovenous fistula: a rare but important consideration.

OBJECTIVE: Spinal dural arteriovenous fistulas (SDAVFs) typically represent abnormal shunts between a radiculomeningeal artery and radicular vein, with the point of fistulization classically directly underneath the pedicle of the vertebral body, at the dural sleeve of the nerve root. However, SDAVFs can also develop in atypical locations or have more than one arterial feeder, which is a variant of SDAVF. The aim of this study was to describe the incidence and multidisciplinary treatment of variant SDAVFs in a single-center case series. METHODS: Following institutional review board approval, the authors retrospectively analyzed their prospectively maintained database of patients with SDAVFs who presented between 2008 and 2020. For all patients, spinal digital subtraction angiograms were reviewed and variant SDAVFs were identified. Variant types of SDAVFs were defined as cases in which the fistulous point was not located underneath the pedicle. Patient demographics, angiographic features, clinical outcomes, and treatment modalities were assessed. RESULTS: Of 59 patients with SDAVFs treated at the authors' institution, 4 patients (6.8%) were identified as having a variant location of the shunt zone, pinpointed on the dura mater at the intervertebral level, further posteriorly within the spinal canal. In 3 cases (75%), a so-called bimetameric arterial supply was demonstrated. CONCLUSIONS: Recognition of the variant type of SDAVF is crucial for management, as correct localization of the fistulous point and bimetameric supply are critical for successful surgical disconnection, preventing delay in achieving definitive treatment.