Onyx Embolization of Intracranial Pial Arteriovenous Fistula

Abstract

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. Computed tomography (CT) of the brain showed a subcortical hematoma in the right temporoparietal lobe. On three-dimensional cerebral artery CT, there was no evidence of definite cerebrovascular abnormality. Cerebral angiography showed a pial AVF supplied by the right middle cerebral artery with early drainage into the right superior cerebral vein. The patient was treated with Onyx embolization for definitive closure of the fistula. The patient was transferred to the department of rehabilitation medicine two weeks later with grade 4 left hemiparesis. The application of advanced equipment, such as the latest angiography and endovascular tools, will facilitate the correct diagnosis and delicate treatment of pial AVF.

Neurosyphilis complicated with pial arteriovenous fistula

“…[10] Therefore, with the development of PAVF, other adverse consequences may have occurred, such as vasogenic edema [10] or hemorrhage. [11,12] Around the PAVF, there was no definite hemorrhage seen in the CT scan, but vasogenic edema was found in the DWI of our patient. It is difficult, however, to determine whether this edema was caused by neurosyphilis or PAVF.…”

Onyx embolization of a pial AV fistula with a giant venous varix using a flow-directed Scepter balloon catheter: Technical note

“…To our knowledge, only two reports of three patients with pial AVFs treated with Onyx embolization exist in the literature. 2,3 While Newman et al 3 used a balloon to achieve flow arrest in their two cases, no one has reported the use of such a flow-directed technique with the Scepter balloon in the cerebral circulation. The main advantages of this technique are:…”

Hemorrhagic Acquired Pial Arteriovenous Fistula Occurring after Mechanical Thrombectomy: A Case Report

“…For superficial lesions, either treatment may be possible, but endovascular treatment may be advantageous for deep or eloquent-area lesions, which are difficult to treat by direct surgery. According to several studies, [11][12][13][14] embolic materials used for endovascular treatment include balloons, coils, glue, polyalcohol, and Onyx. However, if the influx of an embolic material into a draining vein without complete shunt-point disconnection affecting venous outflow occurs, delayed hemorrhage may occur.…”