Abstract
Background A pial arteriovenous fistula (PAVF) is a rare neurovascular pathology consisting
of a direct connection between one or more arterial feeders and a single venous channel.
A PAVF was previously considered a subtype of an arteriovenous malformation (AVM).
In the current literature these are distinguished as two independent entities with
different clinical, physiopathologic, and structural characteristics. We report a
case of a surgically treated 37-year-old woman with an extremely rare combination
of an unruptured PAVF and AVM.
Patient The AVM was mainly supplied by feeders of the middle cerebral artery and drained
into the sigmoid sinus via an abnormally dilated and tortuous vein. Following its
resection, intraoperative digital subtraction angiography (DSA) in the hybrid operating
room revealed the presence of a PAVF that had not been noted during the preoperative
planning. Hence the PAVF was completely disconnected as confirmed by DSA again.
Conclusion This is the second reported case of an AVM-associated PAVF. Without the intraoperative
DSA in the hybrid operating room, this unusual complex cerebrovascular entity would
likely have been missed.
Keywords
arteriovenous malformation - augmented reality - hybrid operating room - pial arteriovenous
fistula
