Onyx Embolization of Intracranial Pial Arteriovenous Fistula

Hae-Min Kim,조재훈,Ki-Hong Kim 대한뇌혈관외과학회 2016 Journal of Cerebrovascular and Endovascular Neuros Vol.18 No.3

Intracranial pial arteriovenous fistulas (AVFs) are rare cerebrovascular lesions consisting of one or more arterial connections to a single venous channel without an intervening nidus. Because of the location and high flow dynamics of these lesions, neurosurgeons may have a difficulty deciding between endovascular treatment and open surgical treatment. We report on a patient who underwent endovascular treatment with liquid embolic agent. A 50-year-old man with a decreased mental state and a tonic seizure event was brought to our hospital. Computed tomography (CT) of the brain showed a subcortical hematoma in the right temporoparietal lobe. On three-dimensional cerebral artery CT, there was no evidence of definite cerebrovascular abnormality. Cerebral angiography showed a pial AVF supplied by the right middle cerebral artery with early drainage into the right superior cerebral vein. The patient was treated with Onyx embolization for definitive closure of the fistula. The patient was transferred to the department of rehabilitation medicine two weeks later with grade 4 left hemiparesis. The application of advanced equipment, such as the latest angiography and endovascular tools, will facilitate the correct diagnosis and delicate treatment of pial AVF.

Intracranial Pial Arteriovenous Fistulas

Lee, Ji-Yeoun,Son, Young-Je,Kim, Jeong-Eun The Korean Neurosurgical Society 2008 Journal of Korean neurosurgical society Vol.44 No.2

Intracranial pial arteriovenous fistula (AVF) is a rare cerebrovascular lesion that has only recently been recognized as a distinct pathological entity. A 41-year-old woman (Patient 1) presented with the sudden development of an altered mental state. Brain CT showed an acute subdural hematoma. A red sylvian vein was found intraoperatively. A pial AVF was revealed on postoperative angiography, and surgical disconnection of the AVF was performed. A 10-year-old boy (Patient 2) presented with a 10-day history of paraparesis and urinary incontinence. Brain, spinal MRI and angiography revealed an intracranial pial AVF and a spinal perimedullary AVF. Endovascular embolization was performed for both lesions. The AVFs were completely obliterated in both patients. On follow-up, patient 1 reported having no difficulty in performing activities of daily living. Patient 2 is currently able to walk without assistance and voids into a diaper. Intracranial pial AVF is a rare disease entity that can be treated with surgical disconnection or endovascular embolization. It is important for the appropriate treatment strategy to be selected on the basis of patient-specific and lesion-specific factors in order to achieve good outcomes.

Intracranial Pial Arteriovenous Fistula Presenting with Hemorrhage: A Case Report

Jin Soo Lee,오창완,Jae Sung Bang,권오기,Gyojun Hwang 대한뇌혈관외과학회 2012 Journal of Cerebrovascular and Endovascular Neuros Vol.14 No.4

Intracranial pial arteriovenous fistula (AVF) is a rare cerebrovascular malformation, which has a single or multiple arterial connections to a single venous channel without intervening nidus, and is different from arteriovenous malformation (AVM). We report on a case of a surgically treated pial AVF. A 15-year-old girl with an altered mental state was brought to our hospital. Computed tomography (CT) showed a subcortical hematoma of approximately 24 ml in her right temporal lobe. Cerebral angiography showed an AVF supplied by the right middle cerebral artery with early drainage into the Sylvian vein and the vein of Labbe. She underwent surgical treatment with feeding artery obliteration using a clip and hematoma removal. The patient was discharged without neurologic deficits. Despite the rarity of pial AVF, for correct diagnosis and treatment, neurosurgeons should recognize this condition. Pial AVF can be managed simply by disconnection of the shunt by surgery or endovascular treatment, and a good result can be achieved.

Pial Arteriovenous Fistula with Giant Varices: Report of Two Cases with Good Surgical Outcome

Morteza Faghih Jouibari,Mehdi Zeinali Zadeh,Masoud Khadivi,Alireza Khoshnevisan,Keisan Moazzeni,Sina Abdollahzade 대한뇌혈관외과학회 2014 Journal of Cerebrovascular and Endovascular Neuros Vol.16 No.2

Pial arteriovenous fistulas (pAVF) are rare vascular lesions consisting ofone or more arterial connections to a single venous channel without anyintervening nidus of vessels or capillaries. Case 1 : A 65-year-old woman with a complaint of headache and lefthand paresthesia was referred to us. Magnetic resonance imagingshowed a large saccular lesion with signal void in the posterior part ofthe right sylvian fissure and catheter angiography showed a giant venousaneurysm fed by one branch of the middle cerebral artery (MCA) anddraining into the vein of Trolard. Case 2 : A 12-year-old boy was transferred to our hospital with a historyof sudden loss of consciousness and hemiplegia. Brain computed tomographyrevealed a massive hemorrhagic mass in the right hemisphere andcerebral angiography showed a pAVF with a large aneurysmal varix,which was fed by multiple branches of the right MCA and draining intothe superior sagittal sinus. Both patients underwent craniotomy and after ligation of vascular connections,aneurysmal varices were removed completely. Surgical resectioncan be a safe method for treatment of pAVFs, particularly in those withlarge varices.

Congenital Pial Arteriovenous Fistula in the Temporal Region Draining into Cavernous Sinus: A Case Report

Ziyin Zhang,Kun Yang,Chaohua Wang,Changwei Zhang,Xiaodong Xie,Jianjian Tang 대한영상의학회 2013 Korean Journal of Radiology Vol.14 No.3

This report concerns a 4-month-old infant with progressive prominent and redness of his left eye since birth. This report concerns a 4-month-old infant with progressive prominent redness of his left eye since birth. Angiography revealed a congenital pial arteriovenous fistula between the temporal branch of the left posterior cerebral artery and left cavernous sinus through the sphenoparietal sinus, a condition not reported in the literature. The fistula was successfully occluded with two micro-coils by vertebrobasilar approach.

Iatrogenic mixed pial and dural arteriovenous fistula after pterional approach for surgical clipping of aneurysm: A case report

Seung-Bin Woo,Young San Ko,Chang-Young Lee 대한뇌혈관외과학회 2023 Journal of Cerebrovascular and Endovascular Neuros Vol.25 No.4

Craniotomy is known as a cause of iatrogenic dural cerebral arteriovenous fistula (AVF). However, mixed pial and dural AVFs after craniotomy are extremely rare and require accurate diagnosis and prompt treatment due to their aggressiveness. We present a case of an iatrogenic mixed pial and dural AVF diagnosed 2 years after pterional craniotomy for surgical clipping of a ruptured anterior choroidal aneurysm. The lesion was successfully treated using single endovascular procedure of transvenous coil embolization through the engorged vein of Labbe and the superficial middle cerebral vein. The possibility of the AVF formation after the pterional approach should always be kept in mind because it usually occurs at the middle cranial fossa, which frequently has an aggressive nature owing to direct cortical venous or leptomeningeal drainage patterns. This complication is believed to be caused by angiogenetic conditions due to coagulation, retraction, and microinjuries of the perisylvian vessels, and can be prevented by performing careful sylvian dissection according to patient-specific perisylvian venous anatomy.

Spontaneous occlusion of a pial arteriovenous fistula after angiography: The role of iodinated contrast media

Seby John,Tanmoy Kumar Maiti,Praveen Kesav,Ashna Arif,Syed Irteza Hussain 대한뇌혈관외과학회 2024 Journal of Cerebrovascular and Endovascular Neuros Vol.26 No.1

Intracranial non-galenic pial arteriovenous fistula (PAVF) is an extremely rare vascular malformation, where one or more pial arteries feeds directly into a cortical vein without any intervening nidus. Though occasionally they can be asymptomatic, neurological symptoms such as headache, seizure, or focal neurological deficit are more common presenting features. Life threatening or fatal hemorrhage is not uncommon, hence needed to be treated more often than not. Spontaneous occlusion of PAVF is reported only four times before. We report a 49-year-old gentleman, who was diagnosed to have a PAVF, possibly secondary to trauma. He presented 5 months and 22 days from initial digital subtraction angiography (DSA) for treatment, and follow-up angiogram showed complete obliteration. He denied any significant event, medication or alternate treatment during this period. His clinical symptoms were stable as well. We postulate iodinated contrast medium induced vasculopathy as a possible cause, which has been described for other vascular pathologies, but never for PAVF.