Intracranial Arteriovenous Fistulas Research Articles

Intracranial Pial Arteriovenous Fistula Caused by Dural Tenting: Case Report

We describe a rare case where a patient developed intracranial pial arteriovenous (AV) fistula due to dural tenting. The patient was a 63-year-old woman who had undergone neck clipping for an unruptured middle cerebral artery (MCA) aneurysm. The surgery was performed without any problems and her postoperative course was uneventful. Two weeks after cerebral angiography operation revealed a pial AV fistula fed by the right MCA and drained into the vein of Trolard through the Sylvian vein which had not existed before surgery. Being diagnosed as de novo pial AV fistula, surgical repair was performed. The AV fistula was located just beneath the dural tenting. The fistulous point was confirmed with fluorescein video angiography and obliterated using a clip. Although rare, we should pay attention to the AV fistula due to dural tenting as the complications of cranial surgery.

Paraplegia in a chiropractic patient secondary to atraumatic dural arteriovenous fistula with perimedullary hypertension: case report

Intracranial dural arteriovenous fistulas are abnormal communications between higher-pressure arterial circulation and lower-pressure venous circulation. This abnormal communication can result in important and frequently misdiagnosed neurological abnormalities.A case of rapid onset paraplegia following cervical chiropractic manipulation is reviewed. The patient’s generalized spinal cord edema, lower extremity paraplegia and upper extremity weakness, were initially believed to be a complication of the cervical spinal manipulation that had occurred earlier on the day of admission. Subsequent diagnostic testing determined the patient suffered from impaired circulation of the cervical spinal cord produced by a Type V intracranial arteriovenous fistula and resultant venous hypertension in the pontomesencephalic and anterior spinal veins.The clinical and imaging findings of an intracranial dural arteriovenous fistula with pontomesencephalic venous congestion and paraplegia are reviewed.This case report emphasizes the importance of thorough and serial diagnostic imaging in the presence of sudden onset paraplegia and the potential for error when concluding atypical neurological presentations are the result of therapeutic misadventure.

Intracranial pial arteriovenous fistula in infancy: a case report and literature review

Intracranial pial arteriovenous fistulas (AVF) are rare vascular malformation especially in the first 2 years of life. The pathology in this age group is associated with greater morbidity and mortality. We report a rare case of 36-day-old male infant with a pial AVF associated with an arterial aneurysm, who presented with intraventricular hemorrhage and hydrocephalus. In addition, an online review of the literatures on pediatric pial AVF was performed using PubMed on published case reports and articles from 1980 to April 2013.

P-025 Qualitative Assessment of Intra-Arterial Cone Beam CT Angiography in Precise Anatomic Localisation and Treatment Planning of Intracranial and Spinal Arteriovenous Fistulas

Background and PurposeDigital subtraction angiography (DSA) is considered the standard for characterisation of intracranial/spinal arteriovenous fistulas (AVFs). Although DSA offers superior spatial and temporal resolution, it is limited by 2D...

E-018 Embolisation of Intracranial Arteriovenous Malformations and Dural Arteriovenous Fistulae Using a Novel Low Profile Distal Access Microcatheter: Initial experience

IntroductionSuccessful endovascular embolisation of intracranial arteriovenous malformations (AVMs) or arteriovenous fistulae (AVFs) requires distal navigation of very small microcatheters to the nidus or fistulous point of the malformation. Such small...

Supraclinoid internal carotid artery–inferior petrosal sinus arteriovenous fistula after high-voltage electrical burn injury

High-voltage electrical burns can cause immediate and long-term neurological and cerebrovascular injuries. The authors present a 21-year-old man who developed an intracranial arteriovenous fistula secondary to high-voltage electrical injury. CT angiography demonstrated a left supraclinoid internal carotid artery (ICA)–inferior petrosal sinus (IPS) fistula. A subsequent angiogram revealed an irregularity of the cavernous and supraclinoid ICA with stenosis involving the supraclinoid segment and a fistulous connection between the ICA and IPS distal to the ophthalmic take-off and proximal to the anterior choroidal artery. The patient underwent a decompressive hemicraniectomy and clip-wrapping of his ICA pseudoaneurysm with successful obliteration of the fistulous connection. To our knowledge, this is the first report of an intracranial arteriovenous fistula secondary to an electrical burn injury.

Surgical flow disconnection of cerebral pial dual-channel arteriovenous fistula with a large varix: the role of anti-platelet agent or anti-coagulation therapy

Intracranial pial arteriovenous fistula (AVF) is a rare cerebrovascular lesion, and the literature is sparse. Most authors insist that simple disconnection of arteriovenous shunting is enough to treat intracral single-channel pial AVF in most cases, either by microsurgery or endovascular embolization without resection of entire vascular malformation. We report an insidious onset of peri-lesional edema formation after abrupt disconnection of AVF shunting with surgical arterial ligation. Treatment entailed anti-platelet and anti-coagulation agent to slow down thrombus formation in intracranial dual-channel pial AVF. We suggest that slowing down thrombus formation in the large varix with anti-platelet and/or anti-coagulation agents seems to be necessary in case of abrupt disconnection of shunting in intracranial single- or dual-channel pial AVF to prevent postoperative cerebral edema or infarction.

Indocyanine Green Videoangiography “In Negative”

Indocyanine green videoangiography (IGV) raises important limitations when we use it in vascular pathology, especially in cases with arterialization of the venous system such as arteriovenous malformations and fistulae. Our objective was to provide a simple procedure that overcomes the limitations of conventional IGV. We define IGV in negative (IGV-IN), so-called because, in its first phase, the vessel to analyze is clipped, and we report 3 cases of intracranial dural arteriovenous fistulae treated with this procedure. In 2011, we applied IGV-IN to 3 patients at our center with Borden type III intracranial arteriovenous fistulae. In all 3 cases, IGV-IN enabled both diagnosis and post-dural arteriovenous fistula exclusion control in 1 integrated procedure no longer than 1 minute, requiring only 1 visualization. IGV-IN is an improvement over the conventional IGV method and is able to provide more information in a shorter period of time. It is an intuitive and highly visual procedure, and, more importantly, it is reversible. Studies with larger samples are necessary to determine whether IGV-IN can further reduce the need for postoperative digital subtraction angiography.

手術治療を行った成人頭蓋内pial AVFの1例

要旨：症例は63歳女性．1週間前から頭痛と言語障害があり当科を受診した．初診時言語表出が低下しており，錯語が著明であった．頭部CTで左側頭頭頂葉皮質下出血を認め同日入院となった．頭部MRIでは出血の原因となる病変は確認できなかった．脳血管撮影で左後側頭動脈の末梢枝からnidusを介すことなく脳表の静脈への動静脈短絡を認めた．Pial arteriovenous fistula(pial AVF)を原因とする皮質下出血と診断した．開頭術を行いすべての動静脈シャントを離断し，血腫を除去した．術後新たな神経症状の出現はなく，言語障害は改善した．Pial AVFは出血発症例に対して保存的治療を行った場合予後が悪いとされているが，適切な治療を行えば再発を予防しうる疾患である．皮質下出血の患者においてはpial AVFも鑑別診断にいれ出血原因の検索を行うべきであると考えられた．

O-016 Radiation exposure during cerebral angiography and neuroembolization in children: analysis of 357 consecutive cases

Introduction/PurposeCatheter-based cerebral angiography and embolization are important tools in managing cerebrovascular diseases in the pediatric population. We concurrently present data on the safety of pediatric neurointervention, demonstrating an overall low...

Open surgical disconnection for congenital, multi-hole, pial arteriovenous fistulae in non-eloquent cortex

Intracranial pial arteriovenous fistulae (pAVFs), a direct shunt between a feeding artery and a venous channel with the absence of a true nidus characteristic of other types of arteriovenous malformations, are rare. We report a seven-year-old girl with an incidental intracranial pAVF. Following partial embolization with a combination of platinum coils and liquid embolic material, this lesion was surgically disconnected and a definitive cure was achieved. Based on the particular characteristics of this lesion-multiple, small arterial feeders, superficial location, and proximity to the non-eloquent cortex-we feel this vascular lesion represents a subset of pAVFs that may be most reasonably and safely treated by open surgery. While staged embolization has recently gained popularity as a treatment option, the additive risk of multiple embolizations as well as repeated exposure to ionizing radiation should not be understated, especially in the pediatric population. Furthermore, given the paucity of data on the long-term effectiveness of embolization, surgery remains an elegant and durable treatment option for pAVFs in carefully selected patients.

Intracranial Pial Arteriovenous Fistula Presenting with Hemorrhage: A Case Report

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.

Pediatric Intracranial Aneurysms: New and Enlarging Aneurysms after Index Aneurysm Treatment or Observation

Children with brain aneurysms may be at higher risk than adults to develop new or enlarging aneurysms in a relatively short time. We sought to identify comorbidities and angiographic features in children that predict new aneurysm formation or enlargement of untreated aneurysms. Retrospective analysis of the University of California-San Francisco Pediatric Aneurysm Cohort data base including medical records and imaging studies was performed. Of 83 patients harboring 114 intracranial aneurysms not associated with brain arteriovenous malformations or intracranial arteriovenous fistulas, 9 (8.4%) developed new or enlarging brain aneurysms an average of 4.2 years after initial presentation. Comorbidities that may be related to aneurysm formation were significantly higher in patients who developed new aneurysms (89%) as opposed to patients who did not develop new or enlarging aneurysms (41%; RR, 9.5; 95% CI, 1.9%-48%; P = .0099). Patients with multiple aneurysms at initial presentation were more likely than patients with a single aneurysm at presentation to develop a new or enlarging aneurysm (RR, 6.2; 95% CI, 2.1%-185; P = .0058). Patients who initially presented with at least 1 fusiform aneurysm were more likely to develop a new or enlarging aneurysm than patients who did not present with a fusiform aneurysm (RR, 22; 95% CI, 3.6%-68%; P = .00050). Index aneurysm treatment with parent artery occlusion also was associated with higher risk of new aneurysm formation (RR, 4.2; 95% CI, 1.3%-13%; P = .024). New aneurysms did not necessarily arise near index aneurysms. The only fatality in the series was due to subarachnoid hemorrhage from a new posterior circulation aneurysm arising 20 months after index anterior circulation aneurysm treatment in an immunosuppressed patient. Patients who presented with a fusiform aneurysm had a significantly greater incidence of developing a new aneurysm or enlargement of an index aneurysm than did those who presented with a saccular aneurysm. In our patient cohort, 8 of the 9 children who eventually developed new or enlarging brain aneurysms initially presented with fusiform aneurysm morphology. Other comorbidities or multiple aneurysms were also common in these patients at initial presentation.

Giant Intracranial Pial Arteriovenous Fistula Treated by Endovascular Intervention

Arteriovenous fistulas (AVF) are rare vascular lesions of the brain that differ from arteriovenous malformations as they present a direct connection between artery and vein, without interposition of the nidus. They are fed by one or more arterial branches, with a single draining vein. Clinically they can be revealed through cerebral hemorrhage, convulsive crisis, neurological deficit, heart failure in neonates and infants, headache, bruit, or intracranial hypertension symptoms. A 30-year-old patient was found unconscious on a public street, presenting a generalized tonic-clonic convulsive crisis. At admission, she presented with ocular proptosis, conjunctival hyperemia and bilateral jugular turgescence. The cranial computed tomography showed diffuse subarachnoid hemorrhage, and the cerebral angiography evidenced a giant intracranial pial AVF with high flow supplied by 2 branches of the left anterior cerebral artery.The patient underwent endovascular treatment in 2 sessions, using a mixture of histoacryl and lipiodol for complete occlusion of the lesion. She was discharged after a month, alert, devoid of motor deficit, and the ocular proptosis and the conjunctival hyperemia had decreased. AVFs are rare vascular lesions that require prompt treatment. The endovascular treatment must be considered, especially when the lesions are deep and the risks of neurological deficit associated with the surgery are high. Endoscopic intervention represents an effective and safe option for the treatment of this type of lesion.

Pial arteriovenous fistula in the posterior fossa

Intracranial pial arteriovenous fistulas (AVFs) are rare congenital abnormality that can cause severe morbidity and mortality, particularly in neonates1. AVFs are rare cerebrovascular lesions of the brain that were considered to be distinct from other arteriovenous malformations (AVMs) by Lasjaunias, in 19862. Intracranial pial AVFs have a single or multiple arterial connections to a single venous channel. They differ from brain AVMs in that they lack a true nidus […] Pial arteriovenous fistula in the posterior fossa

O-014 Intra-arterial cone beam CT angiography for the precise anatomic localization of intracranial and spinal arteriovenous fistulas

PurposeCone beam CT angiography (CBCTA) provides enhanced vascular imaging for neurointerventional treatment planning, particularly of intravascular stents, thromboemboli, in-stent stenosis, and calcifications. In conjunction with traditional digital subtraction angiography (DSA)...

Endovascular Treatment of a Pial Arteriovenous Fistula With Occipital Remodeling Secondary to Giant Torcular Dilation

Intracranial arteriovenous fistulas are vascular malformations in which clinical suspicion and prompt diagnosis, with a subsequent appropriate therapeutic approach, are crucial to avoid the development of irreversible neurological damage or even patient death because these lesions can be associated with heavy bleeding and high mortality rates. The authors present the case of a direct pial arteriovenous fistula in an infant and its unusual presentation as a large occipital protuberance with hard consistency and an audible murmur that produced bone remodeling. The patient was successfully treated by endovascular therapy, with complete regression of the occipital protuberance during follow-up.

A Case of Pial Arteriovenous Fistula with Giant Venous Aneurysm and Multiple Varices Treated with Coil Embolization

Intracranial pial arteriovenous fistulas (AVFs) are rare vascular lesions of the brain. These lesions consist of one or more arterial connection to a single venous channel without true intervening nidus. A 24-year-old woman visited to our hospital because of headache, vomiting, dizziness and memory disturbance that persisted for three days. She complained several times of drop attack because of sudden weakness on both leg. Cerebral angiograms demonstrated a giant venous aneurysm on right frontal lobe beyond the genu of corpus callosum, multiple varices on both frontal lobes fed by azygos anterior cerebral artery, and markedly dilated draining vein into superior sagittal sinus, suggesting single channel pial AVF with multiple varices. Transarterial coil embolization of giant aneurysm and fistulous portion resulted in complete disappearance of pial AVF without complication.

De Novo Intracranial Pial Arteriovenous Fistula After Craniotomy

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.

Endovascular treatment of intracranial pial arteriovenous fistula

Medical School of Ribeirao Preto, University of Sao Paulo, Ribeirao Preto SP, Brazil: Department of Internal Medicine, Division of Radiology; Department of Surgery, Division of Pediatric Neurosurgery. Intracranial pial arteriovenous fistulas (AVFs) are an extremely rare cerebrovascular disease, accounting for 1.6% of all intracranial vascular malformations. It has been recognized as a pathological entity distinct from the arteriovenous malformations (AVMs), due to the direct connection between the feeder artery and the draining vein, without an intervening true nidus. Pial AVFs differ from dural AVFs in that their arterial supply derive from pial and cortical arteries and they are not involved by the leaflets of the dura-mater. They are in their majority considered to be congenital, but they may also occur sporadically or in association with congenital hereditary vasculopathies. The pial AVFs have a significant morbid-mortality secondary to its rupture when not treated. We report a case of intracranial pial fistula in a 2 years-old patient presenting seizures since the neonatal period, emphasizing the angiographic findings and the results of the endovascular treatment.