0
views
0
recommends
+1 Recommend
0 collections
    0
    shares
      • Record: found
      • Abstract: found
      • Article: found
      Is Open Access

      Mini-Pterional Craniotomy for Microsurgical Ligation of a Sylvian Fissure Arteriovenous Fistula

      case-report
      1 , , 1 , 1
      ,
      Cureus
      Cureus
      middle cerebral artery aneurysm, sylvian fissure, venous varix, cognard grading, pial arteriovenous fistula

      Read this article at

      Bookmark
          There is no author summary for this article yet. Authors can add summaries to their articles on ScienceOpen to make them more accessible to a non-specialist audience.

          Abstract

          Pial arteriovenous fistulae (pAVF) are rare lesions, arising from direct fistulation between an artery and vein, with absence of a nidus. We present the surgical treatment of a 22-year-old female found to have a right middle cerebral artery (MCA) pAVF in the Sylvian fissure. The patient underwent a right mini-pterional approach, and careful dissection of the arterial feeder, venous varix and fistulation point. The fistulation point was tested with a temporary clip and intra-operative indocyanine green (ICG) videoangiography. All arterial feeders were identified and ligated. Complete obliteration was confirmed using ICG and post-operative digital subtraction angiography (DSA). The patient made a good recovery with no neurological deficits, and her pulsatile tinnitus stopped. Pial arteriovenous fistulae are rare lesions amenable for a surgical cure in the appropriate context.

          Related collections

          Most cited references6

          • Record: found
          • Abstract: found
          • Article: not found

          Pulsatile tinnitus: imaging and differential diagnosis.

          Pulsatile tinnitus, unlike idiopathic tinnitus, usually has a specific, identifiable cause. Nonetheless, uncertainty often arises in clinical practice about the findings to be sought and the strategy for work-up.
            Bookmark
            • Record: found
            • Abstract: found
            • Article: not found

            Pial arteriovenous fistula: a review of literature.

            Pial arteriovenous fistula (AVF) is a rare vascular lesion, with less than 120 reported cases in the English literatures (Hoh et al., Neurosurgery 2001;49(6):1351). The angio-architecture, clinical course and therapeutic options are all different from arteriovenous malformation (AVM), dural AVM or other intracranial vascular lesions. A review of literatures to analyse the clinical course of pial AVF was carried out. The presence of varix dictates the clinical course and presentation. Paediatric type had high percentage of varix, and mass effect as clinical presentation while the adult type usually manifest by haemorrhage. Disconnection of direct shunting, either by endovascular or surgically, is sufficient to achieve successful treatment; therefore, total resection of the lesion is unnecessary.
              Bookmark
              • Record: found
              • Abstract: found
              • Article: not found

              Transarterial occlusion of solitary intracerebral arteriovenous fistulas.

              Congenital solitary arteriovenous fistulas unassociated with arteriovenous malformations are rare. Five patients with this condition were treated by endovascular procedures: three by transarterial balloon occlusion and two by coil and silk suture embolization. Of the three patients treated by balloon occlusion, complete angiographic obliteration was achieved in two, and one patient had subtotal occlusion resulting from proximal balloon placement. Two of these patients subsequently underwent surgical excision without incident. There were no complications. Two patients were treated with a combination of platinum coils and silk suture embolization, which resulted in complete angiographic obliteration in both. There was one asymptomatic complication consisting of a coil migrating through the fistula and lodging in the lung. While detachable balloons have advantages in allowing test occlusion prior to detachment, the traction required for detachment can limit accurate deposition and place the feeding arteries under undue stretch. Coil and silk suture embolization enable more precise deposition and are probably the agent of choice for closure of solitary arteriovenous connections within the central nervous system.
                Bookmark

                Author and article information

                Journal
                Cureus
                Cureus
                2168-8184
                Cureus
                Cureus (Palo Alto (CA) )
                2168-8184
                7 March 2023
                March 2023
                : 15
                : 3
                : e35873
                Affiliations
                [1 ] Neurosurgery Department, Queen's Hospital, Romford, GBR
                Author notes
                Article
                10.7759/cureus.35873
                10079804
                7cdc486b-2777-47a6-a7c4-85b302f751f0
                Copyright © 2023, Parwez et al.

                This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

                History
                : 6 March 2023
                Categories
                Neurology
                Neurosurgery

                middle cerebral artery aneurysm,sylvian fissure,venous varix,cognard grading,pial arteriovenous fistula

                Comments

                Comment on this article