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. 2021 Oct 5;13(2):234–246. doi: 10.1007/s13239-021-00572-5

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© The Author(s) 2021

Open AccessThis article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/.

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(a) Digital subtraction angiography of the arteriovenous malformation on the right scalp performed through a catheter selectively cannulating the right occipital artery (red arrow) via the right common femoral artery access. The nidus of the arteriovenous malformation (yellow arrow) was identified. (b) The nidus of the arteriovenous malformation (yellow arrow) was then directly punctured percutaneously with a butterfly needle (blue arrow) and its position in the nidus was confirmed with digital subtraction angiography before sclerosant was injected into it. This is known as “direct puncture” technique.