Abstract
Pial arteriovenous fistula (AVFs) are a rare, although clinically significant, vascular anomaly affecting the pediatric population, consisting of a high-flow connection between one or more pial arteries and the venous. In children, the clinical presentation varies according to age, can present with high output cardiac failure, macrocrania, neurodevelopmental delay, seizures, venous infarctions due to venous stenosis or hemorrhage secondary to venous thrombosis. The treatment, is a multimodal approach, most commonly endovascular, is effective in the obliteration of AVF. A case is presented of a previously healthy infant boy with neurological deficit arising from pAVF of the middle and posterior cerebral artery. The pAVF was successfully treated with endovascular occlusion.
Highlights
[1] Once thought to be a type of arteriovenous malformation (AVM), they are recognized as a distinct vascular anomaly
[2] The high rate of arteriovenous shunting and deep venous drainage decreases the efficacy of microsurgical treatment, and nowadays, endovascular treatment of PAVF is preferable.3Transarterial embolization is the primary method of treatment, open surgery and radiosurgery have been employed or a combination
The guiding catheter is placed in the left vertebral artery, a microcatether was placed in the posterior cerebral artery (PCA) ipsilaterally and embolization was performed with 1 cc (NBCA) was safely injected to achieve parcial occlusion of the fistulae with passage of embolizing material inside the venous varix, so the microcateter is repositioned in the vein foot and a embolization is performed with 0,8 cc (NBCA) to achieve complete occlusion
Summary
Pediatric pial arteriovenous fistula (pAVF) are rare vascular lesions of the CNS, characterized by direct arterial connections to a pial venous channel, without an intervening nidus. [1] Once thought to be a type of arteriovenous malformation (AVM), they are recognized as a distinct vascular anomaly. Brain CT, revealed acute intraparenchymatous left subdural hematoma, giant vascular dilatation in left temporal lobe (figure 1). With left decompressive craniotomy, acute and intraparenchymatous subdural hematoma was drained, vessels with active bleeding from vascular malformation were identified, 5mm clip was placed, severe brain edema was observed. An MRI of the brain revealed a giant vascular venous dilatation at left temporal level, with arterio-venous short circuit (figure 2). The guiding catheter is placed in the left vertebral artery, a microcatether was placed in the PCA ipsilaterally and embolization was performed with 1 cc (NBCA) was safely injected to achieve parcial occlusion of the fistulae with passage of embolizing material inside the venous varix, so the microcateter is repositioned (figure 4) in the vein foot and a embolization is performed with 0,8 cc (NBCA) to achieve complete occlusion (figure 4). At the time of the last follow-up, the patient was completely asymptomatic without any neurological deficit
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a callDisclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
