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Case Reports: Novel treatment (new drug/interventions; established drug/procedure in new situation)
Balloon protection of the vein of Labbé during embolisation of a dural arteriovenous fistula
  1. Jasmeet Singh1,
  2. Anna Luisa Kühn1,
  3. Katyucia de Macedo Rodrigues2 and
  4. Ajit S Puri1
  1. 1Department of Radiology, Division of Neurointerventional Radiology, University of Massachusetts Chan Medical School, Worcester, Massachusetts, USA
  2. 2Radiology, Greensboro Radiology, Greensboro, North Carolina, USA
  1. Correspondence to Dr Ajit S Puri; ajit.puri{at}umassmemorial.org

Abstract

We describe a novel technique of vein of Labbé preservation using balloon protection during embolisation of a transverse-sigmoid sinus dural arteriovenous fistula. A patient with refractory Cognard type IV fistula of the left transverse-sigmoid sinus and persistent pulsatile tinnitus underwent successful embolisation of the lesion via transarterial route. During embolisation, a dual lumen balloon was simultaneously inflated within the vein of Labbé, at its orifice in the transverse-sigmoid sinus junction, to prevent embolic reflux. This allowed for liquid embolic embolisation of the fistula via the transarterial route resulting in complete occlusion. The patient recovered well with marked improvement of his tinnitus.

  • Radiology
  • Interventional radiology
  • Ear, nose and throat/otolaryngology
  • Neurology

https://doi.org/10.1136/bcr-2022-252830

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    Footnotes

    • Contributors Concept and design: JS and ASP. Data acquisition: JS, ALK and KdMR. Data analysis and interpretation: all authors. Literature search: ALK and KdMR. First manuscript draft: JS, ALK and ASP. Revision of manuscript for important intellectual content: KdMR. Approval of final manuscript version for submission: all authors.

    • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

    • Case reports provide a valuable learning resource for the scientific community and can indicate areas of interest for future research. They should not be used in isolation to guide treatment choices or public health policy.

    • Competing interests ASP: 1. Consultant for Medtronic Neurovascular, Stryker Neurovascular Balt, Q’Apel Medical, Cerenovus, Microvention, Imperative Care, Agile, Merit, CereVasc and Arsenal Medical, 2. Research grants from NIH, Microvention, Cerenovus, Medtronic Neurovascular and Stryker Neurovascular, 3. Stockholder: InNeuroCo, Agile, Perfuze, Galaxy and NTI. JS, ALK and KdMR have no conflict of interest.

    • Provenance and peer review Not commissioned; externally peer reviewed.