Surgical treatment of the intracranial pial arteriovenous fistula

Abstract

Background:Pial arteriovenous fistula (PAVF) is a rare vascular condition comprising of one or more arterial vessels that are in direct communication with the draining veins. The condition is also characterized by the absence of a nidus. Due to high blood flows, varicose systems adjacent to the fistula appear. The key characteristic of the arteriovenous direct transition is that it offers a treatment option in which interruption of the blood flow can occur without removing the entire lesion. This study presents two cases of PAVF.Case Description:The first case is of a 59-year-old male with lesions in the frontal region, fed by a branch of the right anterior cerebral artery and drained by the frontal basal vein to the sphenoparietal sinus. The second case is of a 3-year-old child with a lesion in the right anterior frontal lobe, fed by a branch of the right middle cerebral artery, which drains into the Trolard vein and was associated with large a venous varix.Conclusion:PAVF is a disease characterized by its rarity, and knowledge of PAVF's clinical presentation is of vital importance in early diagnosis. The treatment of the condition consists of an occlusion of the supply vessel, which can be done by endovascular, microsurgical, or both procedures. Both the cases were successfully treated by microsurgical procedure.

Dual Pathologies: Pial Arteriovenous Fistula in Combination with an Arteriovenous Malformation

“…12 Endovascular interventions are considered less invasive and therefore have emerged as the treatment of choice, especially in lesions with a single feeding artery. 14,15 However, a surgical approach is preferable in complex lesions with multiple arterial feeders and high flow. Goel et al 4 published a series of 14 patients with PAVF successfully treated by surgery without complications or new neurologic deficits.…”

Neurosyphilis complicated with pial arteriovenous fistula

“…Previous studies have shown that PAVF can be successfully treated through closure of the shunt by endovascular [13,14] or surgical means. [15] Unfortunately, the patient chose to leave the hospital and refused further imaging, in spite of the fact that our team strongly emphasized the seriousness of the disease to him.…”

Intracranial non-galenic pial arteriovenous fistula: A review of the literature

“…3 The blood flow of the feeding artery must be reduced in treatment because partial occlusion of the venous varix without the reduction of arterial flow could lead to intraprocedural rupture. 8,37 Treatments for NGPAVF include surgery and endovascular treatment. In areas of easy surgical access, surgeries provide greater benefit.…”

“…Under long-term increased pressure and high turbulence, drainage veins often exhibit varicosis, the formation of a venous varix, and space-occupying effects. 37,38 For instance, Yang et al reviewed the literature in 2011 and found that varices were present in 77.1% of patients, most commonly in pediatric patients, and that the absence of a varix was significantly correlated with hemorrhage. 39 Even drainage veins have multiple varices.…”

“…Madsen 7 Treatment The authors reported five cases of pediatric NGPAVFs, of which three cases were treated with coils combined with NBCA due to the higher flow rate. da Silva 37 Angioarchitecture The authors reported one case of NGAVF with multiple aneurysms in the feeding arteries; the blood flow of the feeding arteries decreased when the aneurysms disappeared after treatment of the NGPAVF.…”