J Cerebrovasc Endovasc Neurosurg.  2012 Dec;14(4):305-308. 10.7461/jcen.2012.14.4.305.

Intracranial Pial Arteriovenous Fistula Presenting with Hemorrhage: A Case Report

• Lee JS
• Oh CW
• Bang JS
• Kwon OK
• Hwang G

• KMID: 1431285
• DOI: http://doi.org/10.7461/jcen.2012.14.4.305

Abstract

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.

Keyword

Intracranial; Pial; Arteriovenous fistula

MeSH Terms

Arteries
Arteriovenous Fistula
Arteriovenous Malformations
Cerebral Angiography
Cerebral Veins
Drainage
Hematoma
Humans
Middle Cerebral Artery
Neurologic Manifestations
Temporal Lobe
Veins

Figure

• 

  Fig. 1 Initial Computed Tomography (CT) and Magnetic Resonance Imaging (MRI) of the patient. [A] CT angiography shows a suspicious abnormal vessel (arrow) around the hematoma on the right temporal lobe. [B] An Arterio-Venous Malformation (AVM) nidus is not observed using enhanced MRI.

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  Fig. 2 Preoperative cerebral angiography of the patient. [A] A possible Arterio-Venous Fistula (AVF) (arrow) is observed around the right Middle Cerebral Artery (MCA) bifurcation. [B] The AVF drains into the Sylvian vein and the vein of Labbe in the early venous phase. [C] A 3 Dimensional (D) image shows the direct connection (arrow) of the right MCA (A) and the surrounding vein (V).

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  Fig. 3 Intraoperative photographs. Black arrow indicates the AVF consisting of the feeding artery (A) and drainage vein (V) show in preoperative angiography.

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  Fig. 4 Cerebral angiography one week postoperatively. [A] The early draining venous flow through the Sylvian vein and the vein of Labbe disappeared. [B] A 3D image shows that the direct connection of the artery and vein is disconnected (arrow).

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