Endovascular Treatment of a Pial Arteriovenous Fistula With Occipital Remodeling Secondary to Giant Torcular Dilation

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.

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Typical subdural contrast effusion secondary to endovascular treatment of a pediatric pial arteriovenous fistula

Interventional Neuroradiology ◽

10.1177/1591019920938965 ◽

2020 ◽

pp. 159101992093896

Author(s):

Wen-Tao Yan ◽

Xiu-Zhen Li ◽

Chang-Xiang Yan ◽

Jia-Chun Liu

Keyword(s):

Endovascular Treatment ◽

Arteriovenous Fistula ◽

Computer Tomography ◽

Sigmoid Sinus ◽

Subdural Effusion ◽

Severe Stenosis ◽

History Of ◽

Pial Arteriovenous Fistula ◽

The Right

Subdural contrast effusion secondary to endovascular treatment is exceptionally rare and might be mistaken as subdural hematoma because of similar hyperattenuation on computer tomography. The authors present the case of a 13-month-old girl with a history of increased head circumference and developmental retardation. Cerebral digital subtraction angiography showed a high-flow pial arteriovenous fistula fed by multiple arteries on the right cerebellar surface, with occlusion of the right sigmoid sinus and severe stenosis of the left sigmoid sinus. Staged endovascular treatments were performed to eliminate the fistula. Follow-up head computer tomography scans performed 3 h after both procedures demonstrated typical high-density subdural effusion with computer tomography attenuation value similar to hemorrhage. These effusions did not aggravate the condition and disappeared spontaneously 32 h after the first treatment and 29 h after the second, respectively.

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Endovascular treatment of a pial arteriovenous fistula of a posteroinferior cerebellar artery with a double origin

Journal of NeuroInterventional Surgery ◽

10.1136/jnis.2010.003749 ◽

2011 ◽

Vol 3 (3) ◽

pp. 233-236 ◽

Cited By ~ 2

Author(s):

L. Guimaraens ◽

A. Casasco ◽

T. Sola ◽

H. Cuellar ◽

S. Miralbes ◽

...

Keyword(s):

Endovascular Treatment ◽

Arteriovenous Fistula ◽

Cerebellar Artery ◽

Pial Arteriovenous Fistula ◽

Double Origin

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Endovascular treatment for intracranial pial arteriovenous fistula with a giant varix: case report

Journal of Neuroendovascular Therapy ◽

10.5797/jnet.4.106 ◽

2010 ◽

Vol 4 (2) ◽

pp. 106-112

Author(s):

Toshiyuki FUJINAKA ◽

Junko KURODA ◽

Hideyuki ARITA ◽

Hajime NAKAMURA ◽

Takeo NISHIDA ◽

...

Keyword(s):

Case Report ◽

Endovascular Treatment ◽

Arteriovenous Fistula ◽

Pial Arteriovenous Fistula

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Role of endovascular embolisation for curative treatment of intracranial non-Galenic pial arteriovenous fistula

Stroke and Vascular Neurology ◽

10.1136/svn-2020-000482 ◽

2020 ◽

pp. svn-2020-000482

Author(s):

Hengwei Jin ◽

Xiangyu Meng ◽

Jiale Quan ◽

Yi Lu ◽

Youxiang Li

Keyword(s):

Endovascular Treatment ◽

Arteriovenous Fistula ◽

Clinical Outcomes ◽

Clinical Information ◽

Curative Treatment ◽

Endovascular Embolisation ◽

Maximal Diameter ◽

Pial Arteriovenous Fistula

Background and purposeThe safety and effectiveness of endovascular treatment for non-Galenic pial arteriovenous fistula (NGPAVF) is inadequately known. The aim of this study is to explore the role of endovascular embolisation for curative treatment of NGPAVF.Materials and methodsPatients with NGPAVF underwent endovascular treatment from January 2011 to November 2019 in our institution were retrospectively reviewed. Demographics, clinical information, treatment details and clinical outcomes were collected. Factors associated with clinical outcomes were statistically analysed.ResultsTwenty patients were included, with a total of 22 (2 patients have 2 fistulas) lesions. A total of 25 procedures were performed and 5 patients underwent 2 procedures. Follow-up ranged from 3 to 84 months (mean=34.5 months). Thirteen (59.1%) lesions in 12 (60.0%) patients acquired immediate occlusion after initial treatment (immediately occluded group) and follow-up confirmed the complete obliteration. A total of 17 (77.3%) lesions in 15 (75.0%) patients were cured at last follow-up. The maximal diameter of feeding arteries (p=0.04) and the maximal diameter of the varix (p=0.01) in immediately occluded group was smaller than non-immediately occluded group. The number of feeding artery (p=0.004) and the maximal diameter of the varix (p<0.001) were much smaller in curative group than non-curative group. Seven patients suffered procedure-related complications. No patients had an increased Modified Rankin Scale (mRS) and all patients had favourable clinical outcome (mRS ≥2) at last follow-up.ConclusionsEndovascular therapy plays an important role in curative treatment of NGPAVF. Patients with less feeding arteries and small varix may be easier to be cured by endovascular embolisation.

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