Development, clinical presentation and endovascular management of congenital intracranial pial arteriovenous fistulas

Paramasivam, Srinivasan; Toma, Naoki; Niimi, Yasunari; Berenstein, Alejandro

doi:10.1136/neurintsurg-2011-010241

Cited by 41 publications

(73 citation statements)

References 20 publications

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“…Studies have suggested that neonates with a PAVF are more likely to present in CHF than older patients. 18,40 This is further supported by the fact that 22 of the 28 patients in our literature review who presented with cardiac failure were in the neonatal period (< 28 days). The average age of patients presenting in CHF was 0.21 ± 0.52 years compared with 6.2 ± 5.4 years for those patients presenting without CHF (p < 0.0001, unpaired ttest).…”

Section: Clinical Presentationsupporting

confidence: 57%

“…40 This increases to a reportedly higher incidence of 17.2% of AVMs in the pediatric population. 52 Limited distinction has been made between the clinical features of this disease in pediatric and adult patients.…”

Section: Discussionmentioning

confidence: 92%

“…30,40 The most common procedurerelated complication reported in the literature was the development of new intracranial hemorrhage occurring in 17 (12.6%) of 135 patients, followed by the development of new neurological deficit (10 [7.4%] of 135 patients; Table 3). Complication rates in series of patients with related malformations, such as vein of Galen aneurysmal malformations, have been reported at 17%-36%.…”

Section: Complications and Outcomesmentioning

confidence: 99%

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An institutional series and literature review of pial arteriovenous fistulas in the pediatric population

Madsen¹,

Lang²,

Pisapia³

et al. 2013

PED

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Object Pial arteriovenous fistulas (PAVFs) are a rare form of cerebrovascular disease that tend to be overrepresented in the pediatric population. There have been limited studies of the clinical features and outcomes in this group of patients. Here, the authors attempt to better delineate this clinical entity with institutional cases and a review of the literature. Methods A retrospective review of cases at our institution was performed to identify all pediatric patients treated for a PAVF between 2000 and 2012. Results Five patients treated for a PAVF were identified. Patients had a mean age of 1.9 years at diagnosis, and the most common presenting symptoms were seizure and macrocephaly. Patients were treated primarily with embolization, and 3 patients required both N-butyl cyanoacrylate (NBCA) glue and coiling. Four of the patients had complete obliteration of the PAVF and had a pediatric overall performance category score of either 1 (n = 3) or 2 (n = 1) at follow-up. There was 1 death due to heart failure. Analysis of the literature review suggested that a younger age or presence of intracerebral hemorrhage (ICH) or congestive heart failure (CHF) at presentation likely predicts a worse prognosis. Older patients presented more often with ICH, whereas younger patients presented significantly more often in CHF. The majority of pediatric patients reported on in the literature were treated with endovascular embolization, most commonly with NBCA glue alone. Most patients (65.4%) in the literature had an excellent outcome without neurological deficit. Conclusions Pial AVFs represent a serious yet rare form of cerebrovascular disease. Pediatric patients with ICH or CHF at presentation or those who are very young are likely to have a worse prognosis. Endovascular management of these patients has greatly changed the natural history of this disease, but the complication and mortality rates suggest the need for continued insights and advances in treatment.

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Section: Clinical Presentationsupporting

confidence: 57%

Section: Discussionmentioning

confidence: 92%

Section: Complications and Outcomesmentioning

confidence: 99%

See 1 more Smart Citation

An institutional series and literature review of pial arteriovenous fistulas in the pediatric population

Madsen¹,

Lang²,

Pisapia³

et al. 2013

PED

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“…In the last years appeared many articles focusing on the PAVFs [1,[3][4][5][6][7][8][9][10][11][12][13][14][15][16]. One of the largest series of patients was published by Lasjaunias and his coworkers [3,14].…”

Section: Discussionmentioning

confidence: 99%

Intracranial pial fistulas in pediatric population. Clinical features and treatment modalities

et al. 2015

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“…Some reports indicate an association with genetic syndromes such as Rendu-Osler-Weber (hereditary hemorrhagic telangiectasia), phosphatase and tensin homolog hamartomatous tumor, Klippel-Trenaunay-Weber, neurofibromatosis, Sturge-Weber and Ehlers-Danlos (2, 9-10). Paramasivam et al (9) have reported a patient had a family history of AVM and pinkish red multiple cutaneous capillary malformation of varying sizes involving the trunk suggestive of RASA1 mutation causing capillary malformation-AVM. However, there is no genetic syndrome and family history of vascular disease in this case.…”

Section: Discussionmentioning

confidence: 99%

Pial arteriovenous fistulas associated with multiple aneurysms presenting as intracerebral hemorrhage: a case report

Cai¹,

Gong²,

Cheng³

et al. 2014

Turkish Neurosurgery

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Intracranial pial arteriovenous fistulas (AVFs) associated with multiple aneurysms of the main feeding arteries are very rare cerebrovascular lesions. We report a unique case of pial AVFs associated with four aneurysms of the feeding anterior cerebral artery (ACA) which presented as intracerebral hemorrhage (ICH), intraventricular hemorrhage (IVH) and spontaneous subarachnoid hemorrhage (SAH). CT angiography (CTA) and digital subtraction angiography (DSA) images demonstrated clearly the direct connection without nidus between the first and second segment of right ACA accompanied by four irregular aneurysms and an abnormally dilated draining vein into the superior sagittal sinus (SSS). Owing to the superficial-seated fistulas, the morphology of feeding arteries and associated four aneurysms and intracranial hemorrhage, the lesions were surgically treated. Postoperative cerebral angiography certified closure of the fistulas and exclusion of the four aneurysms as well as disappearance of early venous drainage. However, subsequent precontrast brain CT showed hydrocephalus underwent left ventriculoperitoneal shunt placement.KEywoRds: Pial arteriovenous fistula, Aneurysm, Cerebral hemorrhage, Angiography, Surgery ÖZ Ana besleyici arterlerin birden fazla anevrizması ile ilişkili intrakraniyal pial arteriyovenöz fistüller (AVF'ler) çok nadir serebrovasküler lezyonlardır. Burada intraserebral kanama (İSK), intraventriküler kanama (İVK) ve spontan subaraknoid kanama (SAK) olarak ortaya çıkan, anterior serebral arterin (ASA) dört anevrizması ile ilişkili benzersiz bir pial AVF olgusu bildiriyoruz. BT anjiyografi (BTA) ve dijital subtraksiyon anjiyografi (DSA) görüntüleri net bir şekilde dört düzensiz anevrizmanın eşlik ettiği, sağ ASA'nın birinci ve ikinci segmenti arasında nidus olmaksızın doğrudan bağlantıyı ve superior sagittal sinüs (SSS) içine anormal genişlemiş drenaj venini göstermiştir. Yüzeysel yerleşimli fistüller, besleyici arterler, ilgili dört anevrizma ve intrakraniyal kanama morfolojisi nedeniyle lezyonlar cerrahi olarak tedavi edildi. Postoperatif serebral anjiyografi hem fistüllerin kapatılması ve dört anevrizmanın eksklüzyonunu hem de erken venöz drenajın ortadan kaldırılmasını doğruladı. Ancak, sonraki prekontrast beyin BT hidrosefali gösterdi ve sola ventriküloperitoneal şant uygulandı.

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Development, clinical presentation and endovascular management of congenital intracranial pial arteriovenous fistulas

Cited by 41 publications

References 20 publications

An institutional series and literature review of pial arteriovenous fistulas in the pediatric population

An institutional series and literature review of pial arteriovenous fistulas in the pediatric population

Intracranial pial fistulas in pediatric population. Clinical features and treatment modalities

Pial arteriovenous fistulas associated with multiple aneurysms presenting as intracerebral hemorrhage: a case report

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