Mixed pial and dural arteriovenous fistula after craniotomy: case report and literature review

Doi, Kazuma; Otani, Naoki; Hayashi, Motohiro; Takeuchi, Satoru; Toyo’oka, Toshimasa; Wada, Koichiro; Mori, Kentaro

doi:10.1080/02688697.2019.1672860

Cited by 3 publications

(16 citation statements)

References 13 publications

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“…The interval between the initial surgery and the diagnosis of the AV shunt was 1 year or less, except for the hemorrhagic cases, with an interval of 20 years. As for the treatment in the cases previously reported, feeder occlusion was performed with surgery in two patients, including additional Gamma-Knife treatment in one 1,5) and endovascular feeder occlusion using absorbable gelatin sponge powder in one, 2) whereas conservative treatment was adopted in two cases, 3,4) in which the superficial temporal artery, previously used for bypass surgery, supplied the shunt. Three of the five patients previously described were diagnosed with AVFs, 1,3,4) one with mixed pial and dural AVF, 5) and one with dural AVF.…”

Section: Discussionmentioning

confidence: 99%

“…A few cases of arteriovenous shunt, in which the arterial blood flow directly entered the pial vein, have been reported. [1][2][3][4][5] We describe the case of a patient with a dural artery-pial vein shunt presented as intracerebral hemorrhage occurring after craniotomy, which was successfully treated with endovascular therapy using a liquid embolic material.…”

Section: Introductionmentioning

confidence: 99%

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A Case of Iatrogenic Dural Artery–Pial Vein Shunt Treated with Endovascular Treatment

Shigematsu

Yokota

Hirayama

et al. 2023

JNET

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Objective: A few cases of postsurgical iatrogenic arteriovenous shunts have been reported, with the arterial blood flow directly entering the pial veins. Herein, we reported a patient with a dural artery-pial vein shunt found 1 year after aneurysmal clipping.Case Presentation: A 64-year-old male presented with generalized convulsion 1 year after cerebral aneurysmal clipping.A CT showed intracerebral hemorrhage in the temporo-occipital cortex and a dural artery-pial vein shunt in proximity to the previous craniotomy center. The arterial blood flow from the deep temporal artery, the middle meningeal artery, and the anterior auricular branch of the superficial temporal artery shunted into the superficial middle cerebral vein, with evident cortical venous reflux. Embolization was performed with n-butyl-2-cyanoacrylate and completely occluded the shunt. The patient was discharged without neurological deficits. Conclusion:Endovascular liquid embolization may be an effective treatment for iatrogenic dural artery-pial vein shunt.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

A Case of Iatrogenic Dural Artery–Pial Vein Shunt Treated with Endovascular Treatment

Shigematsu

Yokota

Hirayama

et al. 2023

JNET

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“…Dural AVFs are defined as AVFs fed by branches of the dural arteries and are lesions occasionally associated with cerebral venous thrombosis, inflammation, trauma, and craniotomy. On the other hand, pial AVFs consist of feeders from the pial arteries, which are related to congenital and various conditions, such as Ehlers-Danlos syndrome and neurofibromatosis type 1 [ 2 , 6 , 7 , 18 ]. Due to the differences in etiology, mixed dural and pial AVF is an extremely rare condition, which has been infrequently reported worldwide [ 6 ].…”

Section: Introductionmentioning

confidence: 99%

“…On the other hand, pial AVFs consist of feeders from the pial arteries, which are related to congenital and various conditions, such as Ehlers-Danlos syndrome and neurofibromatosis type 1 [ 2 , 6 , 7 , 18 ]. Due to the differences in etiology, mixed dural and pial AVF is an extremely rare condition, which has been infrequently reported worldwide [ 6 ].…”

Section: Introductionmentioning

confidence: 99%

“…Some reports have described iatrogenic AVF after various craniotomies, and intraoperative microinjuries, venous thrombosis, and sinus occlusions are known pathophysiologies [ 1 , 4 - 6 , 9 , 10 , 14 , 20 , 25 , 28 , 29 ]. However, AVF formation after aneurysm surgery through the pterional approach is infrequently reported despite the large number of the surgeries worldwide [ 4 , 6 , 25 ].…”

Section: Introductionmentioning

confidence: 99%

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Iatrogenic mixed pial and dural arteriovenous fistula after pterional approach for surgical clipping of aneurysm: A case report

Woo

Lee

2023

J Cerebrovasc Endovasc Neurosurg

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Craniotomy is known as a cause of iatrogenic dural cerebral arteriovenous fistula (AVF). However, mixed pial and dural AVFs after craniotomy are extremely rare and require accurate diagnosis and prompt treatment due to their aggressiveness. We present a case of an iatrogenic mixed pial and dural AVF diagnosed 2 years after pterional craniotomy for surgical clipping of a ruptured anterior choroidal aneurysm. The lesion was successfully treated using single endovascular procedure of transvenous coil embolization through the engorged vein of Labbe and the superficial middle cerebral vein. The possibility of the AVF formation after the pterional approach should always be kept in mind because it usually occurs at the middle cranial fossa, which frequently has an aggressive nature owing to direct cortical venous or leptomeningeal drainage patterns. This complication is believed to be caused by angiogenetic conditions due to coagulation, retraction, and microinjuries of the perisylvian vessels, and can be prevented by performing careful sylvian dissection according to patient-specific perisylvian venous anatomy.

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Non-sinus type dural AVFとpial AVFが流出静脈を共有した1例

Tada,

Tanemura,

Aoki

et al. 2023

Jpn J Neurosurg

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An 82-year-old man was transferred to the emergency department for evaluation of headache and disturbance of consciousness. Computed tomography revealed cerebral hemorrhage in the right occipital lobe and a right acute subdural hematoma. Digital subtraction angiography showed a non-sinus type dural arteriovenous fistula (AVF) in the vicinity of the transverse sinus, which formed a varix in the cortical vein and drained into the superior sagittal sinus. Blood flow was also observed from the right posterior cerebral artery (PCA) into the same cortical vein via a pial AVF. We performed direct surgery for shunt disconnection. Cortical venous drainage of the dural AVF was disconnected in the vicinity of the dura mater. A PCA branch was connected to the same cortical vein, and this shunt point was disconnected. Direct surgery is preferred in patients in whom dural and pial AVFs are observed with shunt points located both on the dura mater and on the brain(as in the present case)because the exact location of the shunt point can be confirmed under direct vision, which facilitates safe and accurate intervention.

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Mixed pial and dural arteriovenous fistula after craniotomy: case report and literature review

Cited by 3 publications

References 13 publications

A Case of Iatrogenic Dural Artery–Pial Vein Shunt Treated with Endovascular Treatment

A Case of Iatrogenic Dural Artery–Pial Vein Shunt Treated with Endovascular Treatment

Iatrogenic mixed pial and dural arteriovenous fistula after pterional approach for surgical clipping of aneurysm: A case report

Non-sinus type dural AVFとpial AVFが流出静脈を共有した1例

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