Giant Intracranial Pial Arteriovenous Fistula Treated by Endovascular Intervention
25 January 2012 (online)
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.
Patient and Methods:
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.
- 1 Limaye US, Siddhartha W, Shrivastav M et al. Endovascular management of intracranial pial arterio-venous fistulas. Neurol India 2004; 52: 87-90
- 2 Lee JY, Son YJ, Kim JE. Intracranial pial arteriovenous fistulas. J Korean Neurosurg Soc 2008; 44: 101-104
- 3 Nakiri GS, Abud TG, Oliveira RS et al. Endovascular treatment of intracranial pial arteriovenous fistula. Arq Neuropsiquiatr 2010; 68: 463-465
- 4 Pillai A, Rajeev K, Unnikrishnan M. Surgical management of a pial arteriovenous fistula with giant varix in an infant. Neurol India 2006; 54: 434-436
- 5 Yamashita K, Ohe N, Yoshimura S et al. Intracranial pial arteriovenous fistula – case report. Neurol Med Chir (Tokyo) 2007; 47: 550-554
- 6 Hoh BL, Putman CM, Budzik RF et al. Surgical and endovascular flow disconnection of intracranial pial single-channel arteriovenous fistulae. Neurosurgery 2001; 49: 1351-1363 discussion 1354–1363
- 7 Youn SW, Han MH, Kwon BJ et al. Coil-based endovascular treatment of single-hole cerebral arteriovenous fistulae: experiences in 11 patients. World Neurosurg 2010; 73: 2-10
- 8 Berenstein A, Ortiz R, Niimi Y et al. Endovascular management of arteriovenous malformations and other intracranial arteriovenous shunts in neonates, infants, and children. Childs Nerv Syst 2010; 26: 1345-1358