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Lim J, Kuo CC, Waqas M, Cappuzzo JM, Monteiro A, Baig AA, Snyder KV, Davies JM, Levy EI, Siddiqui AH. A Systematic Review of Non-Galenic Pial Arteriovenous Fistulas. World Neurosurg 2023; 170:226-235.e3. [PMID: 36087909 DOI: 10.1016/j.wneu.2022.09.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2022] [Revised: 09/02/2022] [Accepted: 09/03/2022] [Indexed: 10/14/2022]
Abstract
OBJECTIVE Non-galenic pial arteriovenous fistulas (NGPAVFs) are rare cerebrovascular pathologies accounting for only 1.6%-4.8% of all brain vascular malformations. We performed a comprehensive review of NGPAVF cases reported in the literature to further characterize their clinical patterns of presentation, angiographic features, management, clinical outcomes, and complications. METHODS We searched PubMed, Google Scholar, and Embase from each database's earliest records to April 2022 for all relevant English language articles. A total of 3280 articles were screened to identify those that met prespecified inclusion criteria. Differences in clinical outcomes between children (≤18 years old) and adults (>18 years old) and those articles in which NGPAVFs were associated with the presence of a varix or a hemorrhage were statistically examined. RESULTS A total of 242 patients in 86 articles were included. The mean patient age was 18.51 ± 18.80 years. The male-to-female ratio was 1.44:1. Headache was the most common initial presentation (42.6%) in the study cohort. Hemorrhage occurred at a significantly higher frequency in adults (P = 0.004), whereas more children presented with congestive heart failure (P < 0.001). Surgical, endovascular, and combination therapy led to comparable rates of complete NGPAVF obliteration (86.8%, 85.2%, and 88.5%, respectively). Fifty-nine patients (24.4%) experienced a complication, ranging from minor neurological deficit to severe hemorrhage. The mortality rate for the overall cohort was 3.3%, and all deceased patients had a varix associated with their fistulas. CONCLUSIONS To our knowledge, we report the largest literature review describing the clinical course and characteristics of NGPAVFs. All treatment approaches resulted in favorable obliteration rates and overall patient outcomes.
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Affiliation(s)
- Jaims Lim
- Department of Neurosurgery, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo New York, USA; Department of Neurosurgery, Gates Vascular Institute at Kaleida Health, Buffalo, New York, USA
| | - Cathleen C Kuo
- Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, New York, USA
| | - Muhammad Waqas
- Department of Neurosurgery, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo New York, USA; Department of Neurosurgery, Gates Vascular Institute at Kaleida Health, Buffalo, New York, USA
| | - Justin M Cappuzzo
- Department of Neurosurgery, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo New York, USA; Department of Neurosurgery, Gates Vascular Institute at Kaleida Health, Buffalo, New York, USA
| | - Andre Monteiro
- Department of Neurosurgery, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo New York, USA; Department of Neurosurgery, Gates Vascular Institute at Kaleida Health, Buffalo, New York, USA
| | - Ammad A Baig
- Department of Neurosurgery, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo New York, USA; Department of Neurosurgery, Gates Vascular Institute at Kaleida Health, Buffalo, New York, USA
| | - Kenneth V Snyder
- Department of Neurosurgery, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo New York, USA; Department of Neurosurgery, Gates Vascular Institute at Kaleida Health, Buffalo, New York, USA; Canon Stroke and Vascular Research Center, University at Buffalo, Buffalo, New York, USA; Jacobs Institute, Buffalo, New York, USA
| | - Jason M Davies
- Department of Neurosurgery, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo New York, USA; Department of Neurosurgery, Gates Vascular Institute at Kaleida Health, Buffalo, New York, USA; Canon Stroke and Vascular Research Center, University at Buffalo, Buffalo, New York, USA; Jacobs Institute, Buffalo, New York, USA; Department of Bioinformatics, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, New York, USA
| | - Elad I Levy
- Department of Neurosurgery, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo New York, USA; Department of Neurosurgery, Gates Vascular Institute at Kaleida Health, Buffalo, New York, USA; Canon Stroke and Vascular Research Center, University at Buffalo, Buffalo, New York, USA; Jacobs Institute, Buffalo, New York, USA; Department of Radiology, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, New York, USA
| | - Adnan H Siddiqui
- Department of Neurosurgery, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo New York, USA; Department of Neurosurgery, Gates Vascular Institute at Kaleida Health, Buffalo, New York, USA; Canon Stroke and Vascular Research Center, University at Buffalo, Buffalo, New York, USA; Jacobs Institute, Buffalo, New York, USA; Department of Radiology, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, New York, USA.
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Yadav N, Kumar A, Hedaoo K, Pande S. Endovascular Management of Intracranial Pial Arteriovenous Fistula with Giant Venous Varix: Case Report and Review of Literature. JOURNAL OF CLINICAL INTERVENTIONAL RADIOLOGY ISVIR 2022. [DOI: 10.1055/s-0042-1750434] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022] Open
Abstract
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.
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Affiliation(s)
- Nishtha Yadav
- Department of Radiology, Super Speciality Hospital, Netaji Subhash Chandra Bose Medical College, Jabalpur, Madhya Pradesh, India
| | - Ambuj Kumar
- Department of Neurosurgery, Super Speciality Hospital, Netaji Subhash Chandra Bose Medical College, Jabalpur, Madhya Pradesh, India
| | - Ketan Hedaoo
- Department of Neurosurgery, Super Speciality Hospital, Netaji Subhash Chandra Bose Medical College, Jabalpur, Madhya Pradesh, India
| | - Sonjjay Pande
- Department of Radiology, Super Speciality Hospital, Netaji Subhash Chandra Bose Medical College, Jabalpur, Madhya Pradesh, India
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Elia C, Minasian T, Noufal M, Chhabra V. Pial-Dural Intracranial Arteriovenous Fistula with Flow-Associated Aneurysmal Rupture-Case Report with Review of Literature and Proposal on the Mechanism of Hemorrhage and Treatment Options. World Neurosurg 2017; 105:1040.e15-1040.e19. [PMID: 28676463 DOI: 10.1016/j.wneu.2017.06.152] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2017] [Revised: 06/22/2017] [Accepted: 06/24/2017] [Indexed: 11/26/2022]
Abstract
BACKGROUND Vascular anomalies in the form of dural arteriovenous fistulas (DAVFs), arteriovenous malformations, and aneurysms are well described in the literature. Pial arteriovenous fistulas (PAVFs) are described to a lesser extent in the literature. When these anomalies are combined, diagnosis and treatment become complex. CASE DESCRIPTION A 55-year-old man presented with PAVF/DAVF with a ruptured flow-related aneurysm in the distal left posterior inferior cerebellar artery, which required surgical clipping and disconnection. We performed a PubMed search of all identifiable cases of PAVFs in adults. We then identified which cases had components of DAVFs and flow-related aneurysms. We identified 51 PAVF cases and identified which patients presented with hemorrhage and the treatment modalities of all cases. Of 51 cases identified, 4 were a DAVF/FRA, and 5 were a PAVF/DAVF. One case of PAVF/DAVF/FRA was identified. CONCLUSIONS The exact mechanism of PAVF/DAVF formation is unknown. Hemorrhage predilection of PAVF/DAVF is more difficult to predict than a sole fistula, likely secondary to the complex flow dynamics. To our knowledge, this literature review is the largest review to date regarding PAVFs in adult patients and can provide insight into decision making when evaluating treatment options.
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Affiliation(s)
- Christopher Elia
- Division of Neurosurgery, Riverside University Health System Medical Center, Moreno Valley, California; Department of Neurosurgery, Kaiser Permanente Fontana Medical Center, Fontana, California, USA.
| | - Tanya Minasian
- Division of Neurosurgery, Riverside University Health System Medical Center, Moreno Valley, California
| | - Mazen Noufal
- Department of Neurosurgery, Kaiser Permanente Fontana Medical Center, Fontana, California, USA
| | - Vaninder Chhabra
- Department of Neurosurgery, Kaiser Permanente Fontana Medical Center, Fontana, California, USA
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Yu J, Shi L, Lv X, Wu Z, Yang H. Intracranial non-galenic pial arteriovenous fistula: A review of the literature. Interv Neuroradiol 2016; 22:557-68. [PMID: 27388601 PMCID: PMC5072213 DOI: 10.1177/1591019916653934] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2016] [Accepted: 05/15/2016] [Indexed: 02/05/2023] Open
Abstract
An intracranial non-galenic pial arteriovenous fistula (NGPAVF) is a direct connection between the intracranial artery and vein without a nidus. NGPAVFs are clinically rare, and the current understanding of NGPAVFs is limited. This study searched PubMed for the currently available literature, and a review of the relevant publications revealed that NGPAVFs require aggressive treatment, spontaneous occlusion is uncommon, and the prognosis following conservative treatment is poor. NGPAVFs can be divided into congenital and traumatic (including iatrogenic) types. Clinically, NGPAVFs are characterized by congestive heart failure, epilepsy, hemorrhage, mass effects, and nerve function deficits. For the imaging examination of NGPAVFs, digital subtraction angiography (DSA) is still the gold standard for diagnosis, although magnetic resonance DSA (MRDSA) and 4D computed tomography angiography (CTA) can also provide hemodynamic data in a non-invasive manner. Current treatments for NGPAVFs include surgical resection and endovascular embolization, both of which can yield clinical improvements. However, potential postoperative complications should be addressed, such as fatal bleeding due to rupture and deep vein thrombosis. Some studies recommend postoperative anticoagulation to reduce postoperative thrombotic complications.
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Affiliation(s)
- Jinlu Yu
- Department of Neurosurgery, First Hospital of Jilin University, Changchun, China
| | - Lei Shi
- Department of Neurosurgery, First Hospital of Jilin University, Changchun, China
| | - Xianli Lv
- Department of Interventional Neuroradiology, Beijing Neurosurgical Institute and Beijing Tiantan Hospital, Beijing, China
| | - Zhongxue Wu
- Department of Interventional Neuroradiology, Beijing Neurosurgical Institute and Beijing Tiantan Hospital, Beijing, China
| | - Hongfa Yang
- Department of Neurosurgery, First Hospital of Jilin University, Changchun, China
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Ji W, Liu A, Lv X, Li Y, Yang X, Jiang C, Wu Z. A case of two pial arteriovenous fistulas with giant venous pouches treated by endovascular coil embolization: Therapy with and without anticoagulation. Interv Neuroradiol 2016; 22:97-100. [PMID: 26647228 PMCID: PMC4757377 DOI: 10.1177/1591019915617322] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2015] [Accepted: 10/14/2015] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Endovascular coil embolization of pial arteriovenous fistulas (AVF) has been reported as an effective treatment. However, venous thrombosis and intracranial hemorrhage developing after endovascular occlusion of a pial AVF have not been adequately reported. CASE DESCRIPTION A 37-year-old man presented with left middle cerebral artery (MCA) AVF and right posterior cerebral artery (PCA) AVF with giant venous pouches. Staged endovascular coil embolization was performed. The MCA AVF was completely occluded by coils at the first stage. Intravenous heparin (3000 IU) was administered during the procedure, and then low molecular weight heparin (subcutaneous injection, 0.4 mL/12 hours) was administered for two days. The PCA AVF was near completely occluded by coils without anticoagulation therapy at the second stage. Rapid progressive venous thrombosis and intracranial hemorrhage were confirmed by computerized tomography brain scan postoperatively, and the patient was then transferred to the neurological intensive care unit for further treatment. Finally, the patient recovered well at the five-month follow-up. CONCLUSIONS Endovascular occlusion of a high-flow pial AVF with a giant venous pouch resulting in significant blood stasis could precipitate thrombosis in the venous system. Further studies are required to establish whether anticoagulation therapy is necessary.
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Affiliation(s)
- Wenjun Ji
- Department of Interventional Neuroradiology, Beijing Neurosurgical Institute, Beijing Tiantan Hospital, Capital Medical University, China
| | - Aihua Liu
- Department of Interventional Neuroradiology, Beijing Neurosurgical Institute, Beijing Tiantan Hospital, Capital Medical University, China
| | - Xianli Lv
- Department of Interventional Neuroradiology, Beijing Neurosurgical Institute, Beijing Tiantan Hospital, Capital Medical University, China
| | - Youxiang Li
- Department of Interventional Neuroradiology, Beijing Neurosurgical Institute, Beijing Tiantan Hospital, Capital Medical University, China
| | - Xinjian Yang
- Department of Interventional Neuroradiology, Beijing Neurosurgical Institute, Beijing Tiantan Hospital, Capital Medical University, China
| | - Chuhan Jiang
- Department of Interventional Neuroradiology, Beijing Neurosurgical Institute, Beijing Tiantan Hospital, Capital Medical University, China
| | - Zhongxue Wu
- Department of Interventional Neuroradiology, Beijing Neurosurgical Institute, Beijing Tiantan Hospital, Capital Medical University, China
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Jouibari MF, Zadeh MZ, Khadivi M, Khoshnevisan A, Moazzeni K, Abdollahzade S. Pial arteriovenous fistula with giant varices: report of two cases with good surgical outcome. J Cerebrovasc Endovasc Neurosurg 2014; 16:98-103. [PMID: 25045649 PMCID: PMC4102757 DOI: 10.7461/jcen.2014.16.2.98] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2014] [Revised: 04/09/2014] [Accepted: 05/02/2014] [Indexed: 11/23/2022] Open
Abstract
Pial arteriovenous fistulas (pAVF) are rare vascular lesions consisting of one or more arterial connections to a single venous channel without any intervening nidus of vessels or capillaries. Case 1: A 65-year-old woman with a complaint of headache and left hand paresthesia was referred to us. Magnetic resonance imaging showed a large saccular lesion with signal void in the posterior part of the right sylvian fissure and catheter angiography showed a giant venous aneurysm fed by one branch of the middle cerebral artery (MCA) and draining into the vein of Trolard. Case 2: A 12-year-old boy was transferred to our hospital with a history of sudden loss of consciousness and hemiplegia. Brain computed tomography revealed a massive hemorrhagic mass in the right hemisphere and cerebral angiography showed a pAVF with a large aneurysmal varix, which was fed by multiple branches of the right MCA and draining into the superior sagittal sinus. Both patients underwent craniotomy and after ligation of vascular connections, aneurysmal varices were removed completely. Surgical resection can be a safe method for treatment of pAVFs, particularly in those with large varices.
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Affiliation(s)
- Morteza Faghih Jouibari
- Department of Neurosurgery, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Mehdi Zeinali Zadeh
- Department of Neurosurgery, Imam Khomeini Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Masoud Khadivi
- Department of Neurosurgery, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Alireza Khoshnevisan
- Department of Neurosurgery, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Keisan Moazzeni
- Department of Neurosurgery, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Sina Abdollahzade
- Department of Neurosurgery, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran
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Kanemaru K, Ezura M, Nishiyama Y, Yagi T, Yoshioka H, Fukumoto Y, Horikoshi T, Kinouchi H. Anchor coil technique for arteriovenous fistula embolization. A technical note. Interv Neuroradiol 2014; 20:283-6. [PMID: 24976089 DOI: 10.15274/inr-2014-10054] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2013] [Accepted: 11/23/2013] [Indexed: 11/12/2022] Open
Abstract
We describe a case of arteriovenous fistula (AVF) successfully treated by coil embolization with an anchor coil inserted in the varix to facilitate dense packing at the shunting site. AVF of the left anterior choroidal artery (AChoA) draining into the ipsilateral basal vein of Rosenthal was incidentally found in a newborn female. A single detachable coil was inserted as an anchor into the varix adjacent to the shunt, and the microcatheter was pulled back to the shunting point. Three more detachable coils were delivered at the shunting point without migration under the support of the anchor coil, and the AVF was successfully obliterated with preservation of AChoA blood flow. The anchor coil technique can reduce the risk of coil migration and the number of coils required.
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Affiliation(s)
- Kazuya Kanemaru
- Department of Neurosurgery, Interdisciplinary Graduate School of Medicine and Engineering, University of Yamanashi; Chuo, Yamanashi, Japan -
| | - Masayuki Ezura
- Department of Neurosurgery, Sendai Medical Center; Sendai, Miyagi, Japan
| | - Yoshihisa Nishiyama
- Department of Neurosurgery, Interdisciplinary Graduate School of Medicine and Engineering, University of Yamanashi; Chuo, Yamanashi, Japan
| | - Takashi Yagi
- Department of Neurosurgery, Interdisciplinary Graduate School of Medicine and Engineering, University of Yamanashi; Chuo, Yamanashi, Japan
| | - Hideyuki Yoshioka
- Department of Neurosurgery, Interdisciplinary Graduate School of Medicine and Engineering, University of Yamanashi; Chuo, Yamanashi, Japan
| | - Yuichiro Fukumoto
- Department of Neurosurgery, Interdisciplinary Graduate School of Medicine and Engineering, University of Yamanashi; Chuo, Yamanashi, Japan
| | - Toru Horikoshi
- Department of Neurosurgery, Interdisciplinary Graduate School of Medicine and Engineering, University of Yamanashi; Chuo, Yamanashi, Japan
| | - Hiroyuki Kinouchi
- Department of Neurosurgery, Interdisciplinary Graduate School of Medicine and Engineering, University of Yamanashi; Chuo, Yamanashi, Japan
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