Pial Arteriovenous Fistula: A Brief Review and Report of 14 Surgically Treated Cases.

OBJECTIVE: The authors report their successful experience of treating 14 cases of pial arteriovenous fistula (PAVF) by direct surgery.

METHODS: During the period January 2010 to April 2017, 14 patients with PAVF were treated by surgery. Only those patients were selected who had a single arterial feeding channel. There were 9 male patients and 5 female patients, and their ages ranged from 5 to 53 years (average, 19 years). Ten patients were younger than 20 years of age. Five patients presented clinical and radiologic features that suggested hemorrhage from the PAVF. Ten patients had seizures. Two patients had hemispheric symptoms or neurologic deficits at the time of presentation. In 12 patients, there were no gross neurologic deficits. The diagnosis was made on the basis of digital subtraction angiography in all patients and computed tomographic angiography in 8 patients. Angiography revealed that the PAVFs in 8 patients were supplied by the middle cerebral artery, in 5 patients by the anterior cerebral artery, and in 1 patient by branches of the basilar artery. Surgical procedures involved identification of the site of fistula, obliteration of the feeding artery, and resection of the entire venous varix.

RESULTS: The PAVF was successfully excluded from circulation in all patients. There were no neurologic deficits related to the surgical procedure.

CONCLUSIONS: Direct surgical resection of the entire PAVF is a safe, effective, and probably curative method of treatment.