Matas test revisited: carotid compression for embolization of high-flow pediatric pial arteriovenous fistulas

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  • 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
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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 technique, 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.

ABBREVIATIONS ACA = anterior cerebral artery; AVF = arteriovenous fistula; EVOH = ethylene vinyl alcohol copolymer; MCA = middle cerebral artery.

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Contributor Notes

Correspondence Zeferino Demartini Jr.: Complexo Hospital de Clinicas, Universidade Federal do Paraná—UFPR, Curitiba, Paraná, Brazil. demartini9@yahoo.com.

INCLUDE WHEN CITING Published online December 18, 2020; DOI: 10.3171/2020.7.PEDS20401.

Disclosures The authors report no conflict of interest concerning the materials or methods used in this study or the findings specified in this paper.

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