Zeferino Demartini Jr., MD,1–3 Gelson Luis Koppe, MD,2,3
Bernardo Corrêa de Almeida Teixeira, MD,4
Adriano Keijiro Maeda, MD, MSc,1,3
Alexandre Novicki Francisco, MD, MSc,2,3 and Luana Antunes Maranha Gatto, MD, MSc3
1
Department of Neurosurgery, Complexo Hospital de Clinicas, Universidade Federal do Paraná—UFPR; 2
Department of
Neurosurgery, Hospital Pequeno Principe; 3
Department of Neurosurgery, Cajuru University Hospital and Pontifical Catholic
University of Paraná, PUCPR; and 4
Department of Radiology, Complexo Hospital de Clinicas, Universidade Federal do Paraná—
UFPR, Curitiba, Paraná, Brazil
OBJECTIVE Cerebral pial arteriovenous fistula (AVF) is a rare vascular malformation and may cause hemorrhage and
neurological deficit. The presence of high-flow shunts constitutes a challenge when performing the endovascular tech-
nique, due to risk of distal embolization. The authors report a simple maneuver, adapted from the Matas test, that was
successfully applied to treat a child with two pial AVFs.
METHODS An 8-year-old boy presented with headache and vomiting due to two single-channel high-flow intracerebral
pial AVFs. He was treated with an endovascular approach using brief, gentle compression of the ipsilateral cervical carotid
artery. The temporary flow arrest ensured proper placement of the first coil, allowing definitive obliteration of the shunt.
RESULTS There were no complications with the procedure, and the patient recovered uneventfully. Throughout the
9-month follow-up, the patient experienced a stable neurological condition, with both fistulas occluded and improvement
of local circulation.
CONCLUSIONS This easy-to-perform maneuver allows precise positioning of embolic material into high-flow shunts to
facilitate treatment of pial AVF.
https://thejns.org/doi/abs/10.3171/2020.7.PEDS20401
KEYWORDS arteriovenous fistula; cerebrovascular disorders; child; endovascular procedures; intracranial
arteriovenous malformations; therapeutic embolization; surgical technique; vascular disorders
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