Pediatric pial arteriovenous fistula located at the bottom of the callosal sulcus presenting with intraventricular hemor
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CASE REPORT
Pediatric pial arteriovenous fistula located at the bottom of the callosal sulcus presenting with intraventricular hemorrhage: a case report and literature review Masashi Kuwabara 1 & Shigeyuki Sakamoto 1 & Takahito Okazaki 1 & Jumpei Oshita 1 & Akira Taguchi 1 & Kaoru Kurisu 1 Received: 14 March 2020 / Accepted: 17 April 2020 # Springer-Verlag GmbH Germany, part of Springer Nature 2020
Abstract Background A pial arteriovenous fistula (pAVF) is a rare condition characterized by a direct connection between a cerebral artery and cerebral vein without an intervening nidus. The prognosis is poor in untreated cases with hemorrhagic manifestations, indicating that surgical treatment is desirable. We describe a successful endovascular treatment for a pediatric case of ruptured pAVF located at the bottom of the sulcus. Clinical description An 11-year-old girl presented with severe headache and mild disturbance of consciousness. Head computed tomography showed hemorrhage in the callosal sulcus and ventricle. Cerebral angiography showed an arteriovenous shunt without a nidus. The branching artery from the pericallosal artery was connected directly to the thalamostriate vein without varix, and the shunt point was located at the bottom of the callosal sulcus. The patient was diagnosed with pAVF involving a single feeder and single drainer. Emergency endovascular transarterial embolization was performed using 20% N-butyl cyanoacrylate, and the shunt disappeared completely without complications. The patient was discharged with no neurological deficits. Conclusion Endovascular treatment is feasible, safe, and effective for pediatric cases of deeply located pAVF. Keywords Callosal sulcus . Child . Deep lesion . Endovascular treatment . Hemorrhage . Pial arteriovenous fistula
Introduction A pial arteriovenous fistula (pAVF) is a condition that involves direct communication between a cerebral artery and a cerebral vein without an intervening nidus [1–3]. It has gradually become recognized since the 1970s as a disease state that is distinct from cerebral arteriovenous malformations [4]. Its frequency is rare, around 1.6–4.7% of all intracranial arteriovenous shunting disorders [5, 6]. It occurs over a broad range of ages, from young to old, and is known to present varying initial symptoms depending on age [7–9]. In contrast to adults with pAVF who present with cerebral hemorrhage, convulsion, and local neurological symptoms, children commonly present with heart failure, headache, and convulsion,
* Masashi Kuwabara [email protected] 1
Department of Neurosurgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, 1-2-3 Kasumi, Minami-ku, Hiroshima-shi, Hiroshima 734-8551, Japan
indicating that its onset with cerebral hemorrhage is extremely rare in children [5–7, 10, 11]. Furthermore, in pial AVF, cerebral hemorrhage often occurs relatively on the surface of the brain because the arteriovenous shunt is subpial [12]. Therefore, it is extremely rare for pediatric pAVF to develop deep cerebral hemor
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