Division of Vascular and Endovascular Neurosurgery, Firoozgar Hospital, Iran University of Medical Sciences, Tehran, Iran.
Department of Neurological Surgery, Weill Cornell Medicine, New York, New York, USA.
World Neurosurg. 2019 Jul;127:245-248. doi: 10.1016/j.wneu.2019.04.061. Epub 2019 Apr 11.
Pial arteriovenous fistulas are abnormal vascular connections between arteries and the cranial venous system on the surface of the brain in the pia mater. In contrast to vein of Galen aneurysmal malformations, they lack a true vascular nidus and may only indirectly involve the vein of Galen.
An 18-month-old boy was referred to us with a history of seizures, drowsiness, bulging cephalic veins, and cranial nerves palsy identified as vein of Galen aneurysmal malformation according to initial magnetic resonance imaging. Digital subtraction angiography showed a vertebrobasilar junction pial high-flow fistula between the basilar artery and anterior pontomesencephalic vein, causing retrograde flow, dilation, and tortuosity of the lateral and posterior mesencephalic vein as well as the vein of Galen. Endovascular treatment, including coil embolization of fistula site, was done successfully without complication resulting in recovery from previous symptoms and signs.
If cerebral venous dilations are encountered, one must keep in mind that the location of the fistula may not be in close proximity to the dilated veins, especially when there is a suspicion for vein of Galen aneurysmal malformation. Other pathologies, such as pial arteriovenous fistula, in a region away from the site of the vein of Galen must be considered.
脑表面软脑膜的动脉与颅静脉系统之间出现异常的血管连接，即软膜动静脉瘘。与静脉瘤样畸形不同，它们缺乏真正的血管核心，可能仅间接累及静脉窦。
一名 18 个月大的男孩因癫痫发作、嗜睡、头静脉膨隆和颅神经麻痹就诊，根据初始磁共振成像，被诊断为静脉瘤样畸形。数字减影血管造影显示基底动脉与前脑桥中脑静脉之间存在椎基底动脉交界处软膜高流量瘘，导致外侧和后部脑桥静脉以及静脉窦逆向血流、扩张和迂曲。成功进行了血管内治疗，包括瘘口线圈栓塞，没有并发症，导致先前的症状和体征恢复。
如果遇到脑静脉扩张，必须记住瘘口的位置可能与扩张的静脉不接近，尤其是当怀疑静脉瘤样畸形时。必须考虑远离静脉窦部位的其他病变，如软膜动静脉瘘。
