An interesting case..an Intra-osseous arteriovenous fistula, but the site of fistula localized between the tables of the skull i.e intraosseous and the initial draining vein is intraosseous. XPER CTA is a high-resolution CT that helps with the localization of fistula. The entire fistula was obliterated by injection of onyx a larva like material into the malformation, draining the vein and retrogradely into all feeding arteries.

Take home:

1. Fistula Localization

2. Deciding which artery to use for embo- the middle meningeal is almost always the best feeder. Smaller caliber allows better forward penetration

3. Squid 12 appears less viscous than Onyx 18 and is used for achieving antegrade penetration.

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