Pedicelli Alessandro, Iacobucci Marta, Frassanito Paolo, Lozupone Emilio, Masselli Gabriele, Di Rocco Concezio, Colosimo Cesare
Department of Radiology, Catholic University of Sacred Heart, Fondazione Policlinico Universitario A. Gemelli, Rome, Italy.
Department of Radiology, Catholic University of Sacred Heart, Fondazione Policlinico Universitario A. Gemelli, Rome, Italy.
World Neurosurg. 2017 Aug;104:1050.e13-1050.e18. doi: 10.1016/j.wneu.2017.05.121. Epub 2017 May 27.
Intracranial pial arteriovenous fistulas (PAVFs) are direct communications between the arterial and venous system of the brain, with the characteristic absence of a plexiform nidus, as seen in the classic cerebral arteriovenous malformations. These vascular malformations, usually occurring in the pediatric population, very rarely are diagnosed in utero, because of a lack of understanding of the condition and because they may be hard to visualize.
We report a rare case of a mass-effect PAVF diagnosed with fetal magnetic resonance imaging, involving the right cerebral hemisphere, fed by a pericallosal artery and associated with a giant venous dilatation. The PAVF initially was managed by the endovascular embolization. The recruitment of a middle cerebral artery feeder and the rapidly enlarging size of the venous pouch with mass effect required subsequent surgery.
The 2-stage multimodal treatment resulted in complete disappearance of the PAVF without complications.
颅内软膜动静脉瘘（PAVF）是脑动脉系统和静脉系统之间的直接连通，其特征是没有典型脑动静脉畸形中所见的丛状病灶。这些血管畸形通常发生在儿童群体中，由于对该病症缺乏了解且可能难以可视化，所以在子宫内很少被诊断出来。
我们报告了一例罕见的通过胎儿磁共振成像诊断出的具有占位效应的PAVF病例，该病例累及右侧大脑半球，由胼周动脉供血，并伴有巨大静脉扩张。该PAVF最初通过血管内栓塞进行治疗。由于招募了大脑中动脉供血支且静脉囊迅速增大并产生占位效应，随后需要进行手术。
两阶段多模式治疗使PAVF完全消失且无并发症。
