De Novo Intracranial Pial Arteriovenous Fistula After Craniotomy

Abstract

Background We describe the case of a patient who developed intracranial pial arteriovenous fistulae near the site at which oxidized regenerated cellulose (ORC) was applied to promote hemostasis during a prior surgery. Case Description The patient was a 67-year-old woman who had undergone craniotomy for treatment of an unruptured aneurysm. Intraoperatively, the patient experienced bleeding from the superficial sylvian vein, and ORC was applied to the site to promote hemostasis. Twenty-one months later, magnetic resonance imaging demonstrated abnormal flow voids in the left sylvian fissure. Cerebral angiography showed a vascular anomaly fed by the left middle cerebral arteries and draining into the left sylvian veins. The vascular lesion was located in the region at which ORC was applied during the previous surgery. The patient underwent neurological and neuroradiological assessments every 4 months without treatment. The last magnetic resonance imaging performed 46 months after the previous surgery showed no interval changes of the lesions. Conclusions ORC may be associated with development of intracranial pial arteriovenous fistulae.