A novel endovascular approach using transcalvarial emissary vein access for scalp and skull base AVMs: Case report
Bibliographic record
Abstract
INTRODUCTION AND IMPORTANCE: Scalp arteriovenous malformations (SAVMs) are rare high-flow vascular lesions with complex angioarchitecture, often involving both superficial and deep components. When the malformation extends toward the skull base or includes deep venous drainage, traditional transarterial or percutaneous access may be insufficient. While direct puncture techniques have gained traction, transosseous access via emissary veins has not previously been described. CASE PRESENTATION: A 12-year-old girl presented with a pulsatile, fluctuant swelling over the left forehead and localized headache. Imaging revealed a mixed-type SAVM involving the left sphenoid ridge, frontal bone, and scalp, supplied by the ophthalmic artery and cortical branches of the middle cerebral artery, with multiple draining veins. Due to tortuous arterial feeders and the risk of non-target embolization, conventional transarterial access was deemed unsafe. A transcalvarial micropuncture technique was employed through a burr hole targeting an emissary vein, granting direct access to a deep venous pouch. Under fluoroscopic guidance, detachable coils were deployed, achieving complete angiographic obliteration. The patient remained neurologically intact, with no complications and an excellent cosmetic outcome. Follow-up imaging at 1, 3, and 6 months showed no recurrence. CLINICAL DISCUSSION: This case demonstrates the feasibility of using a transosseous emissary vein approach for embolization of complex SAVMs. When conventional access is limited, this technique offers precise, direct venous access with reduced morbidity. CONCLUSION: This is the first reported case of SAVM embolization using transcalvarial micropuncture via an emissary vein. The technique presents a novel, safe, and effective adjunct in managing complex scalp AVMs involving the skull base.
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How this classification was reachedexpand
Full frame distilled prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. Learned from the 10,348 direct Codex labels and 10,348 direct Gemma labels. Candidate is the union of thresholded teacher heads; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels or direct frontier model labels.
Codex and Gemma teacher scores by category
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.003 | 0.001 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.001 |
| Bibliometrics | 0.001 | 0.000 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.001 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.000 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one teacher head, not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".