Panigrahi Souvagya, Mishra Sudhansu S, Das Srikant, Parida Deepak K
Department of Neurosurgery, S.C.B. Medical College and Hospital, Cuttack, Odisha, India.
Surg Neurol Int. 2013;4:22. doi: 10.4103/2152-7806.107891. Epub 2013 Feb 27.
Intracerebral pial arteriovenous fistulas (AVFs) are rare vascular lesions of the brain. These lesions are composed of one or more direct arterial connection to a single venous channel without true intervening nidus and usually have associated venous varix or giant venous aneurysms. Intracerebral varices are occasionally associated with high-flow AVF, and usually treated by interrupting the feeding arteries leaving the varices intact.
We report a rare case of a 24-year-old male with a single-channel pial AVF of the left cerebral hemisphere, which was fed by the left anterior cerebral artery (ACA) and was associated with large venous varix and continuous varicose venous dilatation. This superficially located varix was over 6 cm in diameter posing significant mass effect and had calcified walls. Direct surgical flow disconnection followed by removal of large varix resulted in complete disappearance of pial AVF without complication.
Though endovascular occlusion of feeding arteries offers a simple and safe option, direct surgical removal should be considered in rare cases of intracerebral superficially located large AVF with calcified wall and mass effect.
脑软膜动静脉瘘（AVF）是一种罕见的脑部血管病变。这些病变由一条或多条直接的动脉与单一静脉通道相连组成，其间无真正的瘤巢，且通常伴有静脉瘤样扩张或巨大静脉瘤。脑内静脉曲张偶尔与高流量AVF相关，通常通过阻断供血动脉来治疗，而使静脉曲张保持完整。
我们报告一例罕见病例，一名24岁男性患有左侧大脑半球单通道软膜AVF，由左侧大脑前动脉（ACA）供血，伴有大型静脉瘤样扩张和持续性静脉曲张性扩张。这个位于浅表的静脉曲张直径超过6厘米，产生了显著的占位效应，且其壁已钙化。直接进行手术切断血流，随后切除大型静脉曲张，导致软膜AVF完全消失，且无并发症发生。
尽管通过血管内栓塞供血动脉是一种简单且安全的选择，但对于罕见的位于脑浅表、具有钙化壁和占位效应的大型AVF病例，应考虑直接进行手术切除。
