The Usefulness of Subcutaneous Infiltration of Epinephrine-Containing Lidocaine for Curative Transarterial Embolization of Dural Arteriovenous Fistula

Abstract

<jats:p> Recently, transarterial embolization (TAE) with liquid embolic materials has been recognized as one of the curative therapeutic options for non-sinus type dural arteriovenous fistula (d-AVF). To prevent glue fragmentation and incomplete obliteration, flow reduction of transosseous high-flow feeders is one of the key points of this therapy. However, flow reduction of transosseous feeders is sometimes difficult with previously reported techniques such as particle embolization, manual compression, or proximal balloon occlusion. This report introduces a new technique to reduce the flow of transosseous feeders using epinephrine-containing lidocaine, and describes a case of intracranial d-AVF successfully treated with this technique. The usefulness and efficacy of the technique are discussed. </jats:p>

Manual superficial temporal artery compression using a circular plastic material for embolization of meningioma: illustrative case

“…Although previous studies have reported methods to control blood flow in the STA, these methods have been used mostly in transarterial embolization (TAE) of dural arteriovenous fistulas 6 , 7 and rarely in tumor embolization. Onishi et al 4 reported a method for controlling control blood flow in the STA by occluding the proximal portion of the STA with coils.…”

“…Onishi et al 4 reported a method for controlling control blood flow in the STA by occluding the proximal portion of the STA with coils. Yamauchi et al 7 reported the use of subcutaneous infiltration of epinephrine-containing lidocaine to control the blood flow from the STA during TAE of dural arteriovenous fistulas. Omura et al 12 reported a damp-and-push technique for embolization of dural arteriovenous fistulas while preserving cutaneous vessels.…”

“…Several studies have reported on how to control blood flow from the STA. 4 , 6 , 7 Occlusion of the STA with an embolic material is undesirable, because it may adversely affect wound healing, considering the subsequent tumor removal procedure. 5 Furthermore, as compared with the MMA, the STA is very tortuous, and guiding microcatheters to the feeding vessels near the tumor is not easy.…”