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Congenital Intracerebral Pial Arteriovenous Fistula: A Case Report
Shun-Bao Xin1,2, Guang-Bin Wang1, Wen-Juan Liu3
1Department of Radiology, Shandong Research Institute of Medical Imaging in Shandong University, Shandong, People's Republic of China.
Insights
Congenital pial arteriovenous fistula (AVF) in a child caused mass effect. Endovascular embolization successfully treated the rare intracranial vascular lesion, leading to complete disappearance on follow-up imaging.
Area of Science:
- Neurology
- Vascular Surgery
- Pediatric Neurosurgery
Background:
- Pial arteriovenous fistula (AVF) is a rare intracranial vascular malformation.
- Pediatric AVFs often present with varix, causing mass effect and neurological symptoms.
Observation:
- A 12-year-old boy presented with acute confusion and urinary incontinence.
- Imaging confirmed a congenital pial AVF originating from the left middle cerebral artery and draining into the superior sagittal sinus.
Findings:
- Endovascular embolization using microcoils and ethylene vinyl alcohol copolymer was performed via a middle cerebral artery approach.
- The procedure successfully obliterated the AVF without neurological deficits.
- Follow-up imaging demonstrated AVF shrinkage and eventual disappearance.
Implications:
- This case highlights the successful endovascular treatment of a rare pediatric pial AVF.
- Minimally invasive treatment can lead to excellent outcomes and complete radiological resolution.
- Early diagnosis and intervention are crucial for managing symptomatic AVFs in children.
Abstract:
Pial arteriovenous fistula (AVF) is an extremely rare intracranial vascular lesion. The pediatric type of AVF has a high percentage of varix, leading to mass effect with symptoms. We report a 12-year-old boy who was admitted due to sudden confusion and urinary incontinence. Computed tomography, magnetic resonance imaging, and magnetic resonance angiography (MRA) confirmed the diagnosis of congenital pial AVF. Digital subtraction angiography (DSA) revealed the lesion originating from the left middle cerebral artery and draining into the superior sagittal sinus. The AVF was successfully obliterated with six microcoils and 2.5-mL ethylene vinyl alcohol copolymer using a middle cerebral artery approach. This patient was discharged without neurologic deficits. The AVF became smaller and ultimately disappeared on the DSA and MRA at follow-up.
