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CC BY-NC-ND 4.0 · Journal of Clinical Interventional Radiology ISVIR
DOI: 10.1055/s-0042-1750434
Case Report

Endovascular Management of Intracranial Pial Arteriovenous Fistula with Giant Venous Varix: Case Report and Review of Literature.

Nishtha Yadav 
1   Department of Radiology, Super Speciality Hospital, Netaji Subhash Chandra Bose Medical College, Jabalpur, Madhya Pradesh, India
,
Ambuj Kumar
2   Department of Neurosurgery, Super Speciality Hospital, Netaji Subhash Chandra Bose Medical College, Jabalpur, Madhya Pradesh, India
,
Ketan Hedaoo
2   Department of Neurosurgery, Super Speciality Hospital, Netaji Subhash Chandra Bose Medical College, Jabalpur, Madhya Pradesh, India
,
Sonjjay Pande
1   Department of Radiology, Super Speciality Hospital, Netaji Subhash Chandra Bose Medical College, Jabalpur, Madhya Pradesh, India
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Abstract:

Background: Intracranial pial arteriovenous fistulas (AVFs) are rare intracranial vascular malformation and their treatment is challenging because of high-flow pial supply of the lesion. We report a case of intracranial pial AVF with associated giant venous varices managed successfully by embolization.

Case Description: A 25-year-old male presented with sudden onset headache and altered sensorium. Computed tomographic scan was suggestive of frontal lobar hematoma that had dissected into the third ventricle with associated intraventricular hemorrhage. Magnetic resonance imaging revealed presence of large vascular channels with the presence of multiple flow voids in bilateral frontal location. Digital subtraction angiography revealed pial fistula with arterial supply from hypertrophied left anterior cerebral artery. Treatment was done using combined coil and onyx embolization after careful analysis of angioarchitecture of the lesion using three-dimensional rotational angiogram cross-sectional reconstructions. Postprocedure angiogram revealed closure of fistula and giant varices.

Conclusion: Pial AVFs with giant venous varix in adults are rare vascular malformation and understanding the angioarchitecture with exact identification of fistulous point is important to plan for surgical/endovascular management strategies. Combined strategy of embolization using coils and onyx is a safe option in such cases with giant varices.

Keywords

pial arteriovenous fistula - giant venous varices - embolization - coils - onyx - vascular malformation


Publication History

Received: 02 August 2020

Accepted: 09 June 2021

Article published online:
11 July 2022

© 2022. Indian Society of Vascular and Interventional Radiology. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)

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