Combined Surgery for Pial Arteriovenous Fistula with Giant Varix: A Case Report

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  • THAPA Shanta
    Department of Neurosurgery, Graduate School of Medical and Dental Sciences, Kagoshima University
  • TANAKA Shunichi
    Department of Neurosurgery, Graduate School of Medical and Dental Sciences, Kagoshima University
  • YONENAGA Masanori
    Department of Neurosurgery, Graduate School of Medical and Dental Sciences, Kagoshima University
  • KUROKI Shinichi
    Department of Neurosurgery, Graduate School of Medical and Dental Sciences, Kagoshima University
  • NAGANO Yushi
    Department of Neurosurgery, Graduate School of Medical and Dental Sciences, Kagoshima University Department of Neurosurgery, Imamura General Hospital
  • HIWATARI Takaaki
    Department of Neurosurgery, Graduate School of Medical and Dental Sciences, Kagoshima University
  • KITAZONO Ikumi
    Department of Human Pathology, Field of Oncology, Graduate School of Medical and Dental Sciences, Kagoshima University
  • SUGATA Sei
    Department of Neurosurgery, Graduate School of Medical and Dental Sciences, Kagoshima University Birounoki Neurosurgical Hospital
  • YAMAHATA Hitoshi
    Department of Neurosurgery, Graduate School of Medical and Dental Sciences, Kagoshima University
  • YOSHIMOTO Koji
    Department of Neurosurgery, Graduate School of Medical and Dental Sciences, Kagoshima University

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  • 巨大静脈瘤を伴ったpial arteriovenous fistulaに対し複合治療を行った1例

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<p>Intracranial pial arteriovenous fistula (pAVF) is uncommon, accounting for approximately 1.6% of all intracranial vascular malformations. High flow pressure renders varices and AVF highly susceptible to rupture and life-threatening hemorrhage.</p><p>A 15-year-old girl who presented with headache and visual disturbance was diagnosed with an intracranial pAVF associated with a giant varix in the right occipital lobe. Imaging studies showed anomalous dilatation of the right posterior cerebral artery, a 53 mm thrombosed and calcified varix in the right occipital lobe, and drainage into the transverse sinus. We planned a combined surgery with the goal of reducing the mass and curing the pAVF. The patient underwent coil embolization for the obliteration of an angiographic shunt point; however, shunt flow appeared from the new feeders. We resected the giant varix with an angiographic shunt point completely and safely, with embolization the following day. The patient was discharged without any postoperative intracranial complications. The pathological shunt point was confirmed.</p><p>Recently, reports on endovascular surgery for pAVF have increased. Combined surgery that includes safe excision, particularly in cases with mass effects, is required.</p>

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