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Pial fistula

Prabath Kumar Mondel, Rashmi Saraf, Uday S Limaye
A rete mirabile is a vascular network of intercommunicating small arteries or arterioles that replace the definitive adult artery supplying the brain. It supplies the brain in lower mammals but is not seen in normal human embryological development. A 26-year-old man presented with worsening tinnitus that was interfering with his sleep. On CT and digital subtraction angiography he was found to have a temporal lobe pial arteriovenous fistula with bilateral carotid and vertebral rete mirabile. The patient was offered open surgical and endovascular treatment options for pial arteriovenous fistula but he refused both and opted for conservative medical management...
February 16, 2017: BMJ Case Reports
Mako Ago, Kenichi Masumoto, Atsushi Uchiyama, Yasuo Aihara, Yoshikazu Okada, Satoshi Kusuda
Background Pial arteriovenous fistula (AVF) is composed of one or more direct arterial feeding vessels with a single draining vein without nidus. A patient with the disease with high-flow AV shunting in the neonatal period not only suffers from high-output cardiac failure but also shows secondary neurological sequelae. In vein of Galen aneurysmal malformation, superior vena cava (SVC) flow measurements provide useful prognostic information. Case Presentation We measured serial SVC flow in a male infant with pial AVF...
January 2017: American Journal of Perinatology Reports
Mark K Lyons, Joseph M Hoxworth, Jamal McClendon, Chandan X Krishna, Naresh P Patel
Pial arteriovenous fistulae (AVFs) are rare vascular abnormalities that are distinct from arteriovenous malformations and dural AVFs. These vascular lesions have been linked with trauma, ischemic syndromes, venous thrombotic diseases, and intracranial surgical procedures. In this report we describe a case of an intracranial ruptured pial AVF immediately following uneventful spinal surgery in an elderly patient with subsequent spontaneous resolution. He was a previous heavy smoker with a 60-pack-year history and alcohol abuse...
January 1, 2017: Neuroradiology Journal
Jesús A Morales-Gómez, Vicente V Garza-Oyervides, José A Arenas-Ruiz, Mariana Mercado-Flores, C Guillermo Elizondo-Riojas, Frederick A Boop, Ángel Martínez-Ponce de León
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...
January 6, 2017: Journal of Neurosurgery. Pediatrics
Hae-Min Kim, Jae-Hoon Cho, Ki-Hong Kim
Intracranial pial arteriovenous fistulas (AVFs) are rare cerebrovascular lesions consisting of one or more arterial connections to a single venous channel without an intervening nidus. Because of the location and high flow dynamics of these lesions, neurosurgeons may have a difficulty deciding between endovascular treatment and open surgical treatment. We report on a patient who underwent endovascular treatment with liquid embolic agent. A 50-year-old man with a decreased mental state and a tonic seizure event was brought to our hospital...
September 2016: Journal of Cerebrovascular and Endovascular Neurosurgery
Yasunari Niimi
Intracranial arteriovenous shunts (ICAVSs) in young children are characterized with frequent high flow fistulas. In association of high flow fistulas and physiological condition of the developing brain and heart, each disease tends to present at a certain age with unique symptoms. Vein of Galen aneurysmal malformation (VGAM) and dural sinus malformation (DSM) with arteriovenous (AV) shunts tend to present in neonate with high output cardiac failure. In infancy, VGAM, pial AVF and infantile dural AVF tend to present with hydrodynamic disorder such as macrocephaly, ventriculomegaly, prominent facial veins, and developmental delay...
September 7, 2016: Pediatrics International: Official Journal of the Japan Pediatric Society
Hiroyuki Sakata, Miki Fujimura, Kenichi Sato, Kuniyasu Niizuma, Hidenori Endo, Teiji Tominaga
Cerebral proliferative angiopathy (CPA), which is characterized by diffuse vascular abnormalities with intermingled normal brain parenchyma, is a rare clinical entity distinct from classical cerebral arteriovenous malformations. Its pathology at initial state and subsequent course of progression has totally been undetermined. We herein presented a case of a child who was initially diagnosed with deep-seated arteriovenous fistula (AVF), and ultimately developed symptomatic CPA-like vascular lesion over a long period of clinical follow-up...
October 2016: Journal of Stroke and Cerebrovascular Diseases: the Official Journal of National Stroke Association
Farhan A Mirza, Justin F Fraser
CASE: A 24-year-old woman presented with headache, nausea, and vomiting, and was found to have chronic superior sagittal sinus (SSS) thrombosis and multiple dural arteriovenous fistulae (dAVFs). Despite anticoagulant therapy and successful recanalization of her sinus, her fistulae persisted, and she developed additional separate pial arteriovenous fistulae (pAVFs). Her fistulae were treated with staged endovascular embolization, open clipping, and gamma knife radiosurgery over the course of 10 months...
October 2016: Journal of Stroke and Cerebrovascular Diseases: the Official Journal of National Stroke Association
Chao-Bao Luo, Feng-Chi Chang, An-Guor Wang, Chung-Jung Lin, Wan-Yuo Guo, Ta-Wei Ting
BACKGROUND: Transvenous coil embolization is an effective method to manage cavernous sinus dural arteriovenous fistulas (CSDAVFs). However, some CSDAVFs may be associated with complex angioarchitecture, leading to difficult access. In this article we report our experience with coil embolization of CSDAVFs. METHODS: Over a 5-year period, 70 patients (24 men and 46 women; mean age, 60 years) underwent coil embolization of a total of 73 CSDAVFs at our institution. We retrospectively analyzed and categorized the CSDAVFs based on a revised classification scheme as proliferative type (PT), restrictive type (RT), or late restrictive type (LRT)...
November 2016: World Neurosurgery
Kasra Khatibi, Omar Choudhri, Ian D Connolly, Ryan A McTaggart, Huy M Do
BACKGROUND: Trigeminal-cardiac reflex (TCR) from the stimulation of sensory branches of trigeminal nerve can lead to hemodynamic instability. This phenomenon has been described during ophthalmologic, craniofacial, and skull base surgeries. TCR has been reported rarely with endovascular onyx embolization of dural arteriovenous fistulas. CASE DESCRIPTION: We report a case of TCR during endovascular Onyx embolization of an arteriovenous malformation (AVM). A 16-year-old boy presented with a large cerebellar AVM with arterial feeders from the external carotid artery and posterior cerebral artery branches...
July 17, 2016: World Neurosurgery
Jinlu Yu, Lei Shi, Xianli Lv, Zhongxue Wu, Hongfa Yang
An intracranial non-galenic pial arteriovenous fistula (NGPAVF) is a direct connection between the intracranial artery and vein without a nidus. NGPAVFs are clinically rare, and the current understanding of NGPAVFs is limited. This study searched PubMed for the currently available literature, and a review of the relevant publications revealed that NGPAVFs require aggressive treatment, spontaneous occlusion is uncommon, and the prognosis following conservative treatment is poor. NGPAVFs can be divided into congenital and traumatic (including iatrogenic) types...
October 2016: Interventional Neuroradiology
Qi Wu, Xiang-Sheng Zhang, Han-Dong Wang, Qing-Rong Zhang, Li-Li Wen, Chun-Hua Hang, Xin Zhang
OBJECTIVE: We describe treatment with Onyx embolization in a series of cases of tentorial dural arteriovenous fistula (DAVF) with pial arterial supply. The aim of this study was to analyze the cause of intraoperative hemorrhage and to explore therapeutic strategies. METHODS: Retrospective review was performed of 53 consecutive patients with DAVF treated by Onyx embolization between February 2009 and December 2014. Tentorial DAVF with pial arterial supply was diagnosed in 6 patients (2 women and 4 men; mean age, 47...
August 2016: World Neurosurgery
W Brinjikji, V N Iyer, V Yamaki, G Lanzino, H J Cloft, K R Thielen, K L Swanson, C P Wood
BACKGROUND AND PURPOSE: Hereditary hemorrhagic telangiectasia is associated with a wide range of neurovascular abnormalities. The aim of this study was to characterize the spectrum of cerebrovascular lesions, including brain arteriovenous malformations, in patients with hereditary hemorrhagic telangiectasia and to study associations between brain arteriovenous malformations and demographic variables, genetic mutations, and the presence of AVMs in other organs. MATERIALS AND METHODS: Consecutive patients with definite hereditary hemorrhagic telangiectasia who underwent brain MR imaging/MRA, CTA, or DSA at our institution from 2001 to 2015 were included...
August 2016: AJNR. American Journal of Neuroradiology
Anand Alurkar, Lakshmi Sudha Prasanna Karanam, Suresh Nayak, Rajesh Kumar Ghanta
Pial arteriovenous fistulae (AVF) are rare vascular lesions comprising single or multiple arterial feeders draining directly into the venous channel without intervening tangle of blood vessels as in brain AV malformations. In our present paper, we describe three cases of pial AVF in the pediatric age group with different presentations treated successfully with endovascular and surgical methods. Two patients underwent treatment for pial AVF by the endovascular technique and one by surgical clipping. The treatments were successful with good clinical outcome...
2016: Journal of Clinical Imaging Science
H K Yang, J W Lee, S E Jo, C Jung, O-K Kwon, E Lee, J M Ahn, H S Kang
AIM: To investigate the magnetic resonance imaging (MRI) findings of spinal arteriovenous fistulas (AVFs) to predict their locations and types. MATERIALS AND METHODS: Patients who underwent spinal angiography for suspected spinal AVF between April 2003 and April 2013 were enrolled. Spine MRI images were analysed by two radiologists in consensus focusing on the distribution patterns of flow void pial vessels (FVPVs): longitudinal distribution pattern along the spinal level (even or uneven, with description of the most crowded level in uneven cases) and axial distribution pattern in relation to the cord (ventral, dorsal, or co-dominance)...
April 2016: Clinical Radiology
Masaki Komiyama, Aiko Terada, Tomoya Ishiguro
Neonatal neuro-intervention is challenging. The purpose of this article is to report the neuro-intervention for the neonates with brain arteriovenous fistulas (AVFs), with special reference to access routes. Fifteen neonates (12 boys and 3 girls) who underwent neuro-intervention within the first 14 days of life were -included. Their diagnoses included vein of Galen aneurysmal malformation (6), dural sinus malformations with arteriovenous (AV) shunts (6), pial AVF (2), and epidural AVF (1). Birth weight ranged from 1,538 g to 3,778 g (mean 2,525 g)...
2016: Neurologia Medico-chirurgica
Christopher S Hong, Anthony C Wang, Robert H Bonow, Isaac J Abecassis, Catherine Amlie-Lefond, Richard G Ellenbogen
BACKGROUND: VACTERL association is characterized by a group of congenital malformations that tend to occur together. Rarely, concurrent cerebrovascular abnormalities have been reported. In this article, we present the first reported case of moyamoya disease in a patient with VACTERL association. CASE DESCRIPTION: The patient presented in the neonatal period with esophageal atresia with distal tracheoesophageal fistula as well as an imperforate anus. He also had a ventricular septal defect and persistent foramen ovale...
May 2016: World Neurosurgery
Chao-Bao Luo, Feng-Chi Chang, Michael Mu Huo Teng, Chung-Jung Lin, An-Guor Wang, Ta-Wei Ting
BACKGROUND: Most cavernous sinus dural arteriovenous fistulas (CSDAVFs) present with benign neuro-ophthalmic symptoms. CSDAVFs manifesting with aggressive neurologic symptoms are rare. The purpose of this study was to analyze the different angioarchitectures of aggressive CSDAVFs and to report our experiences of embolization. METHODS: Over the past 10 years, a total of 118 CSDAVFs were managed by embolization. From the databases containing such patient information, nine patients (7...
March 2016: Journal of the Chinese Medical Association: JCMA
Wenjun Ji, Aihua Liu, Xianli Lv, Youxiang Li, Xinjian Yang, Chuhan Jiang, Zhongxue Wu
BACKGROUND: Endovascular coil embolization of pial arteriovenous fistulas (AVF) has been reported as an effective treatment. However, venous thrombosis and intracranial hemorrhage developing after endovascular occlusion of a pial AVF have not been adequately reported. CASE DESCRIPTION: A 37-year-old man presented with left middle cerebral artery (MCA) AVF and right posterior cerebral artery (PCA) AVF with giant venous pouches. Staged endovascular coil embolization was performed...
February 2016: Interventional Neuroradiology
Santhosh Kannath, Enakshy Rajan Jayadevan
BACKGROUND: Medullary-bridging vein dural arteriovenous fistula (DAVF) is an uncommon type of DAVF with an aggressive clinical course due to direct fistulous shunting into medullary and brainstem veins. Important considerations need to be given to retrograde embolic migration or perforator involvement while treating these fistulas endovascularly with a liquid embolic agent. We report a lateral spinal artery feeding the DAVF, the recognition of which is important to avoid potential catastrophic complications during definitive therapy, and which has not been described before...
October 27, 2015: Neurosurgery
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