Coexistence of a Dural Arteriovenous Fistula and Pial Arteriovenous Malformation Sharing a Common Drainer

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In cases of a dural arteriovenous fistula (AVF) with a pial arterial supply, postoperative hemorrhagic complications occur frequently. Six cases in which patients were diagnosed with a coexisting dural AVF and pial arteriovenous malformation (AVM) sharing a common drainer are presented. These cases were initially thought to be dural AVFs with pial arterial supplies, but careful examination of preoperative images showed that a pial AVM coexisted near the dural AVF, and that both shared a common drainer. The coexistence of a pial AVM is difficult to notice during surgery; for this reason, determining the presence of a pial AVM on preoperative imaging is essential to safely treat a dural AVF with a pial arterial supply. The details of each case, specifically, the diagnostic evidence for this condition (coexisting dural AVF and pial AVM sharing a common drainer), as well as imaging findings that should be noted, are presented.