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Felipe Constanzo, Bernardo Correa de Almeida Teixeira, Mauricio Coelho Neto, and Ricardo Ramina

Inadvertent laceration of the jugular bulb is a potentially serious complication of the retrosigmoid transmeatal approach to vestibular schwannomas. Here, the authors present the case of a 51-year-old woman with a right Hannover T4a vestibular schwannoma and bilateral high-riding jugular bulb, which was opened during drilling of the internal auditory canal (IAC). They highlight the immediate management of this complication, technical nuances for closing the defect without occluding the jugular bulb, and modifications of the standard technique needed to continue surgical resection.

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Zeferino Demartini Jr., Gelson Luis Koppe, Bernardo Corrêa de Almeida Teixeira, Adriano Keijiro, Alexandre Novicki Francisco, and Luana Antunes Maranha Gatto


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.


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.


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.


This easy-to-perform maneuver allows precise positioning of embolic material into high-flow shunts to facilitate treatment of pial AVF.