Pial arteriovenous fistula resulting from ventriculostomy

Ventriculostomy complications are well documented in the literature. We report the first known example of an arteriovenous fistula created during passage of a ventriculostomy catheter for the treatment of hydrocephalus.

A 47-year-old female patient initially presented with a subarachnoid hemorrhage and an anterior communicating artery aneurysm. The patient underwent coil embolization followed by a ventriculostomy catheter for hydrocephalus. After recovery, a follow-up angiogram demonstrated a new arteriovenous fistula at the site of the ventriculostomy. A craniotomy was performed at the site of the ventriculostomy burr-hole site. Indocyanine green videoangiography confirmed the site of the fistula.

The fistulous point was coagulated and divided and confirmed with both indocyanine green videoangiography and intraoperative diagnostic angiography. The patient recovered without deficit.

This is the first reported case of a pial arteriovenous fistula from a ventriculostomy catheter. The formation of a fistula can occur from trauma to cortical arteries and veins at the pial entry site. Although rare, vascular injury and subsequent fistula formation may form in patients in whom catheter tract hemorrhages occur after catheter placement.