AneurysmSurgical treatment of pial cerebellar arteriovenous fistulas with aneurysm of the main feeding artery
Introduction
Intracranial pAVFs are rare vascular lesions that have only recently been acknowledged as distinct from AVMs. They consist of a single or, more frequently, multiple arterial connections to a single venous channel without any intervening nidus of vessel or capillaries. They may be localized anywhere in the brain but display a preference for the supratentorial regions [17]. Pial arteriovenous fistulas can be acquired traumatically or iatrogenically or may be congenital. Their natural evolution is unfavorable; conservative management of pAVFs fistulas has been associated with mortality in 63% of patients [25]. Owing to the absence of a nidus, closure of the shunt by either endovascular or surgical technique represents a satisfactory therapeutic procedure [18].
We present the case of a 54-year-old woman with a pial cerebellar fistula of the left hemisphere, which was fed by the right PICA and the right superior cerebellar artery, and was associated with a small fusiform dilatation of the third segment as well as an aneurysm of the fourth segment of the PICA. We were unable to find any similar cases described by either English- or French-speaking authors. The surgical treatment of this case is described in the light of other possible therapeutic options.
Section snippets
Case report
A 54-year-old woman presented with abrupt onset of severe posterior headache and vomiting. Neurological examination showed disorientation, impaired attentiveness, and cerebellar ataxia. Computerized tomography (CT) scan documented the presence of a hematoma in the fourth ventricle, with mild dilatation of the supratentorial ventricular system. Angiography revealed a pAVF fed by a branch of the fourth segment of the PICA and branches of the superior cerebellar artery (Fig. 1A). There was also a
Discussion
Intracranial pAVF has only recently been distinguished from AVMs [18]. They consist of one or more arterial connections to a single venous channel without any intervening nidus of vessels or capillaries. They are rare vascular lesions. In fact, in a series of 320 AVMs reported by Halbach et al [14], single-channel arteriovenous fistulas accounted for 1.6% of all lesions. In the surgical series of 419 brain AVMs by Yasargil [35], pAVF accounted for 2.4% of the total.
Intracranial pAVFs differ
Conclusions
Only recently, pAVFs have been recognized as a pathological entity distinct from AVMs. They are characterized by the absence of a nidus and their high-flow nature. Because their prognosis appears very poor, endovascular or surgical treatment is recommended.
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2017, World NeurosurgeryCitation Excerpt :Articles not available in English or articles that could not be retrieved were excluded. The literature review of adults with PAVF yielded 51 (24 men and 27 women) identifiable cases (Table 1).7,10,12,15-45 Of 51 patients, 20 (39%) presented with hemorrhage; the remaining 31 patients presented with neurologic symptoms commonly secondary to the mass effect from the venous varix or other vascular abnormality.
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2011, World NeurosurgeryCitation Excerpt :Willis circle aneurysms have a greater rate of a subarachnoid hemorrhage. Flow-related aneurysms may develop as a result of increased intravascular shearing stresses secondary to the increased blood flow of AVMs acting on the vascular wall proximal to AVMs (6, 13, 14). This hypothesis is supported by a report in which the authors demonstrated that some extranidal aneurysms exhibited marked shrinkage during the course of endovascular AVM treatment (20).
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