Intracranial Pial Arteriovenous Fistulae: Diagnosis and Treatment Techniques in Pediatric Patients with Review of Literature

Alurkar, Anand; Karanam, Lakshmi Sudha Prasanna; Nayak, Suresh; Ghanta, Rajesh K

doi:10.4103/2156-7514.175083

Cited by 16 publications

(8 citation statements)

References 8 publications

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“…The treatment strategy in each case has to be made by the team of neurosurgeons and neurointerventionists to identify the best effective method based on patient-specific presentation and angioarchitecture. 16 In our case, a two-staged surgical procedure using a simple and widely available technique (a combination of a liquid embolic agent [Histoacryl with Lipiodol] and GDCs) resulted in the total occlusion of PAVF-DAVF. Cerebral venous thrombosis is a terrible complication after the endovascular embolization of PAVF.…”

Section: Discussionmentioning

confidence: 76%

Endovascular Treatment of Intracranial Pial–Dural Arteriovenous Fistula: A Case Report

Shchehlov¹,

Konotopchyk²,

Svyrydiuk³

et al. 2020

Surg J (N Y)

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AbstractIntracranial pial arteriovenous fistula (PAVF) is a rare cerebrovascular pathology characterized by abnormal direct high-flow connection between the pial or cortical feeding artery and draining vein. Dural arteriovenous fistula (DAVF) is a pathological shunt between the meningeal arteries and dural sinuses or meningeal veins. In case of association between PAVF and DAVF, diagnosis and treatment are more challenging. The high-flow arteriovenous shunt and deep venous drainage make PAVF more preferable for endovascular treatment; however, their embolization during single-session procedures can lead to extensive thrombosis of the draining veins and unfavorable outcomes. We present a case report of endovascular embolization of an intracranial PAVF–DAVF in a 2.5-year-old child. At the time of admission, the patient had hydrocephalus, mental retardation, pyramidal insufficiency, and seizures. Occlusion of the fistula was performed during two stages of embolization to reduce the risk of severe venous stasis and venous thrombosis. Guglielmi detachable coils (GDCs) and a liquid embolic agent (Histoacryl with Lipiodol) were used for embolization. The patient recovered well after the procedure, with significant mental improvement. This suggests that the deployment of GDCs in the afferent artery near a fistula before embolization with a liquid embolic agent can minimize the risk of uncontrolled penetration of the embolization into the draining veins and dural sinus. A multisession procedure can be an effective and reasonable method of PAVF and DAVF occlusion among existing treatment options.

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Section: Discussionmentioning

confidence: 76%

Endovascular Treatment of Intracranial Pial–Dural Arteriovenous Fistula: A Case Report

Shchehlov¹,

Konotopchyk²,

Svyrydiuk³

et al. 2020

Surg J (N Y)

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“…Due to lack of nidus, the existing higher pressure gradient, which can make such lesions more prone for rupture, leading to relatively worse prognosis. [ 7 ] It has been reported the case of a pial AVM with dural substitution associated with dural venous sinus thrombosis. The pial fistulas that occur in the 1 st years of life may be associated with disease syndromes such Rendu-Osler-Weber and Klippel-Trenaunay-Weber syndromes.…”

Section: Discussionmentioning

confidence: 99%

Endovascular Management of Intracranial Pial Arteriovenous Fistulas: Experience of Largest Series at a Single Center Over Six Years

Zenteno

Lee

Satyarthee

et al. 2018

Journal of Neurosciences in Rural Practice

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Introduction:Intracranial pial fistulas are an extremely uncommon type of vascular pathology consisting of one or multiple arterial connections to a single venous drainage channel without the presence of an intervening nidus. Due to its typical location and high-flow dynamics, its management is difficult and options include endovascular treatment and open surgical treatment. The arterial supply of these lesions is usually derived from pial or cortical vessels, and commonly such lesions are not localized in the dura mater.Materials and Methods:Authors report the experience of consecutive ten cases managed at the Instituto Nacional de Neurología y Neurocirugía “Manuel Velasco Suárez” of México extending from 2007 to 2012 with endovascular technique, constituting one of the largest series in the Western literature.Discussion:Pial fistulas are associated with a poor natural history, and the selection of individualized therapeutic strategies can provide good outcomes.Conclusion:The neuroendovascular intervention is currently considered as safe, low cost, and effective management modality for such lesions.

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“…14,17,38,39,43 The technique is challenging because of the high-flow nature of the fistula and because distal migration of embolic agents through the shunt cannot be easily controlled; inadvertent migration of these agents into the veins may result in immediate hemorrhage by venous outflow obstruction. 2,13,20,28 We decided to use NBCA in our patient in combination with coils because of our vast experience using this material.…”

Section: Discussionmentioning

confidence: 99%

“…These are distinguished from a dural AVF by the location of the fistula site in the subpial meningeal space, and from a vein of Galen malformation, by the lack of direct involvement of the embryonic median prosencephalic vein. 2,15,24,32,36,43 Clinical presentation depends on age, mass effect, hemodynamic steal, or venous hypertension. In the newborn a pial AVF usually presents with congestive heart failure, increasing head circumference, or focal neurological deficit.…”

mentioning

confidence: 99%

Hydrocephalus in a patient with an unruptured pial arteriovenous fistula: hydrodynamic considerations, endovascular treatment, and clinical course

Morales-Gómez

Garza-Oyervides

Arenas-Ruiz

et al. 2017

PED

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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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Intracranial Pial Arteriovenous Fistulae: Diagnosis and Treatment Techniques in Pediatric Patients with Review of Literature

Cited by 16 publications

References 8 publications

Endovascular Treatment of Intracranial Pial–Dural Arteriovenous Fistula: A Case Report

Endovascular Treatment of Intracranial Pial–Dural Arteriovenous Fistula: A Case Report

Endovascular Management of Intracranial Pial Arteriovenous Fistulas: Experience of Largest Series at a Single Center Over Six Years

Hydrocephalus in a patient with an unruptured pial arteriovenous fistula: hydrodynamic considerations, endovascular treatment, and clinical course

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