Occult Brain Arteriovenous Malformation Superimposed on a Pial Arteriovenous Fistula: Case Report

2021 ◽  
pp. 1-6
Author(s):  
Ryan R.L. Phelps ◽  
Kunal P. Raygor ◽  
Matthew R. Amans ◽  
Nalin Gupta ◽  
Adib A. Abla
Keyword(s):  
Arteriovenous Malformation ◽  
Arteriovenous Fistula ◽  
Intraoperative Imaging ◽  
Mass Effect ◽  
Preoperative Imaging ◽  
Unique Case ◽  
Case Presentation ◽  
Arteriovenous Fistulas ◽  
Spontaneous Intracranial Hemorrhage ◽  
Pial Arteriovenous Fistula

<b><i>Introduction:</i></b> Pial arteriovenous fistulas are characterized by an abnormal connection between an intracranial artery and vein without an intervening nidus. Their predominant symptoms largely arise from mass effect, shunting, or hemorrhage. Most conservatively managed cases progress to death, but endovascular and/or surgical intervention is often successful. <b><i>Case Presentation:</i></b> We present the unique case of a 15-year-old girl with spontaneous intracranial hemorrhage from a single-vessel arteriovenous fistula. Although preoperative imaging failed to show a distinct nidus, intraoperative indocyanine green angiography performed after successful clipping of the primary fistulous site revealed residual shunting from a peri-lesional arteriovenous malformation. <b><i>Discussion/Conclusion:</i></b> This case demonstrates the importance of intraoperative imaging and meticulous circumferential inspection of these lesions to detect residual vascular shunting.

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

2020 ◽  
Vol 81 (02) ◽  
pp. 185-187
Author(s):  
Gianpaolo Jannelli ◽  
Holger Joswig ◽  
Gianmarco Bernava ◽  
Torstein R. Meling ◽  
Philippe Bijlenga
Keyword(s):  
Arteriovenous Malformation ◽  
Arteriovenous Fistula ◽  
Operating Room ◽  
Preoperative Planning ◽  
Structural Characteristics ◽  
Sigmoid Sinus ◽  
Direct Connection ◽  
Digital Subtraction ◽  
Hybrid Operating Room ◽  
Pial Arteriovenous Fistula

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.

Transvenous embolization for a purely intraorbital arteriovenous fistula

2005 ◽  
Vol 103 (4) ◽  
pp. 756-759 ◽  
Author(s):  
Jun Deguchi ◽  
Makoto Yamada ◽  
Ryusuke Ogawa ◽  
Toshihiko Kuroiwa
Keyword(s):  
Arteriovenous Malformation ◽  
Arteriovenous Fistula ◽  
Visual Function ◽  
Clinical Management ◽  
Ophthalmic Artery ◽  
Transvenous Embolization ◽  
Content Type ◽  
Arteriovenous Fistulas ◽  
Fine Print

✓ Purely intraorbital arteriovenous fistulas (AVFs) are rare, and their clinical management is controversial. The authors successfully treated a patient with an intraorbital AVF by transvenous embolization alone. An accurate distinction between an arteriovenous malformation (AVM), which is characterized by the existence of a nidus, and an AVF, which has no nidus, is important and requires superselective ophthalmic artery angiography. Treatment of an intraorbital AVF by transvenous embolization can improve visual function.

Congenital Intracerebral Pial Arteriovenous Fistula: A Case Report

2017 ◽  
Vol 79 (02) ◽  
pp. 173-176 ◽  
Author(s):  
Shun-Bao Xin ◽  
Guang-Bin Wang ◽  
Wen-Juan Liu ◽  
Qiang Liu
Keyword(s):  
Magnetic Resonance ◽  
Middle Cerebral Artery ◽  
Arteriovenous Fistula ◽  
Cerebral Artery ◽  
Mass Effect ◽  
Vascular Lesion ◽  
Left Middle Cerebral Artery ◽  
Ethylene Vinyl Alcohol ◽  
Sagittal Sinus ◽  
Pial Arteriovenous Fistula

AbstractPial arteriovenous fistula (AVF) is an extremely rare intracranial vascular lesion. The pediatric type of AVF has a high percentage of varix, leading to mass effect with symptoms. We report a 12-year-old boy who was admitted due to sudden confusion and urinary incontinence. Computed tomography, magnetic resonance imaging, and magnetic resonance angiography (MRA) confirmed the diagnosis of congenital pial AVF. Digital subtraction angiography (DSA) revealed the lesion originating from the left middle cerebral artery and draining into the superior sagittal sinus. The AVF was successfully obliterated with six microcoils and 2.5-mL ethylene vinyl alcohol copolymer using a middle cerebral artery approach. This patient was discharged without neurologic deficits. The AVF became smaller and ultimately disappeared on the DSA and MRA at follow-up.

scholarly journals Hydrocephalus in a patient with an unruptured pial arteriovenous fistula: hydrodynamic considerations, endovascular treatment, and clinical course

2017 ◽  
Vol 19 (3) ◽  
pp. 307-311 ◽  
Author(s):  
Jesús A. Morales-Gómez ◽  
Vicente V. Garza-Oyervides ◽  
José A. Arenas-Ruiz ◽  
Mariana Mercado-Flores ◽  
C. Guillermo Elizondo-Riojas ◽  
...  
Keyword(s):  
Endovascular Treatment ◽  
Arteriovenous Fistula ◽  
Clinical Course ◽  
Vascular Malformations ◽  
Pediatric Population ◽  
Unusual Presentation ◽  
Arteriovenous Fistulas ◽  
Pial Arteriovenous Fistula ◽  
Ventricular Shunting

Intracranial pial arteriovenous fistulas, also known as nongalenic fistulas, are rare vascular malformations affecting predominantly the pediatric population. Hydrocephalus is an unusual presentation in which the exact pathophysiology is not fully understood. The aim of treatment in these cases is occlusion of the fistula prior to considering ventricular shunting. Here, the authors describe the hydrodynamic considerations of the paravascular pathway and the resolution of hydrocephalus with endovascular treatment of the fistula.

scholarly journals Delayed Onset of Dural Arteriovenous Fistula Following Trauma

Reports ◽  
2019 ◽  
Vol 2 (2) ◽  
pp. 14
Author(s):  
William Richardson ◽  
Praveen Satarasinghe ◽  
Michael T. Koltz
Keyword(s):  
Arteriovenous Fistula ◽  
Dural Arteriovenous Fistula ◽  
Delayed Diagnosis ◽  
Type Ii ◽  
Unique Case ◽  
Arteriovenous Fistulas ◽  
Delayed Onset ◽  
Dural Arteriovenous Fistulas ◽  
Medical Histories ◽  
Hospital Days

Dural Arteriovenous Fistulas (dAVF) are pathological shunts that are often idiopathic in presentation. However, it is reported that many patients presenting with dAVF have past medical histories notable for surgeries, hypercoagulation disorders, infections, and trauma. In trauma-linked dAVF, presentation generally occurs within 48 h post-incident. In the present case, the authors discuss the delayed onset of a Borden type II dAVF in a patient 12 hospital days post-trauma, as well as the course of treatment. This unique case provides a compelling demonstration for providers to be aware of the development of dAVF, even after the typical 48-hour post-trauma window. By being aware of the possibility of delayed dAVF presentation, delayed diagnosis or misdiagnosis can be avoided and emergent action can be taken.

scholarly journals Vein of Galen Aneurysms

2001 ◽  
Vol 7 (1_suppl) ◽  
pp. 99-103 ◽  
Author(s):  
M. Komiyama ◽  
H. Nakajima ◽  
M. Nishikawa ◽  
K. Yamanaka ◽  
Y. Iwai ◽  
...  
Keyword(s):  
Arteriovenous Malformation ◽  
Arteriovenous Fistula ◽  
Critical Role ◽  
Clinical Manifestations ◽  
Endovascular Intervention ◽  
Vein Of Galen ◽  
Arteriovenous Fistulas ◽  
Dural Arteriovenous Fistulas

Eleven patients with so-called “vein of Galen aneurysms” are reported, six of whom presented with vein of Galen aneurysmal malformations (four with choroidal type and two with mural type malformations). The remaining five patients presented with vein of Galen aneurysmal dilatations secondarily due to an arteriovenous malformation in one patient, an arteriovenous fistula in another, dural arteriovenous fistulas in two patients, and a varix in another. Treatments for these patients were individualised with consideration given to the clinical manifestations and the angioarchitecture of their lesions. Endovascular Intervention played a critical role in the treatment of these vein of Galen aneurysms.

scholarly journals Microsurgical treatment of a posterior fossa arteriovenous malformation initially mistaken for a dural arteriovenous fistula: avoidance of near disaster

2021 ◽  
Vol 4 (1) ◽  
pp. V7
Author(s):  
Brian M. Howard ◽  
Daniel L. Barrow
Keyword(s):  
Arteriovenous Malformation ◽  
Arteriovenous Fistula ◽  
Posterior Fossa ◽  
Arteriovenous Malformations ◽  
Dural Arteriovenous Fistula ◽  
Transvenous Embolization ◽  
Arteriovenous Fistulas ◽  
Fatal Hemorrhage ◽  
Hemorrhagic Complications ◽  
Dural Arteriovenous Fistulas

Many brain arteriovenous malformations (AVMs) derive dural blood supply, while 10%–15% of dural arteriovenous fistulas (dAVFs) have pial arterial input. To differentiate between the two is critical, as treatment of these entities is diametrically opposed. To treat dAVFs, the draining vein(s) is disconnected from feeding arteries, which portends hemorrhagic complications for AVMs. The authors present an operative video of a subtle cerebellar AVM initially treated as a dAVF by attempted embolization through dural vessels. The lesion was subsequently microsurgically extirpated. The authors show a comparison case of an AVM mistaken for a dAVF and transvenous embolization that resulted in a fatal hemorrhage.The video can be found here: https://youtu.be/eDeiMrGoE0Q

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