Surgical treatment of intracranial pial arteriovenous fistula in adult: case report

Abstract

Pial arteriovenous fistulas (AVFs) are rare intracranial vascular lesions that have recently been established as a distinct clinical entity from other vascular malformations. We report a case of hemorrhagic intracranial pial AVF successfully treated with surgery. A 63-year-old woman presented with a one-week history of headache and sensory dysphasia. Computed tomography showed a subcortical hematoma approximately 30 mm in diameter in the left temporoparietal lobe. Magnetic resonance imaging failed to disclose the cause of the hemorrhage. Cerebral angiography confirmed pial AVF with a feeding artery arising from the left posterior temporal artery and a single superficial draining vein. Left temporoparietal craniotomy was performed. Some small branches originated from the feeding artery and connected directly to the superficial draining vein. The AVF was extirpated by electrocoagulation and the hematoma was removed. The postoperative course was uneventful and her sensory dysphasia improved. Postoperative angiography showed the obliteration of the AVF. This case suggests that we should consider the possibility of this clinical entity in patients with subcortical hematoma. In patients with hemorrhagic intracranial pial AFV, early shunt obliteration should be performed, because conservative treatment has been associated with poor prognosis.