Turkish Neurosurgery 2014 , Vol 24 , Num 5
Pial Arteriovenous Fistulas Associated with Multiple Aneurysms Presenting as Intracerebral Hemorrhage: A Case Report
Wu CAI1, Jianping GONG1, Bochao CHENG2, Fang QIAO1, Wei ZHANG1, Qing ZHU3, Qing LAN3
1Second Affiliated Hospital of Soochow University, Department of Radiology, Suzhou, P.R. China
2West China Hospital of Sichuan University, Department of Radiology, Chengdu, P.R. China
3Second Affiliated Hospital of Soochow University, Department of Neurosurgery, Suzhou, P.R. China
DOI : 10.5137/1019-5149.JTN.9255-13.1 Intracranial pial arteriovenous fistulas (AVFs) associated with multiple aneurysms of the main feeding arteries are very rare cerebrovascular lesions. We report a unique case of pial AVFs associated with four aneurysms of the feeding anterior cerebral artery (ACA) which presented as intracerebral hemorrhage (ICH), intraventricular hemorrhage (IVH) and spontaneous subarachnoid hemorrhage (SAH). CT angiography (CTA) and digital subtraction angiography (DSA) images demonstrated clearly the direct connection without nidus between the first and second segment of right ACA accompanied by four irregular aneurysms and an abnormally dilated draining vein into the superior sagittal sinus (SSS). Owing to the superficial-seated fistulas, the morphology of feeding arteries and associated four aneurysms and intracranial hemorrhage, the lesions were surgically treated. Postoperative cerebral angiography certified closure of the fistulas and exclusion of the four aneurysms as well as disappearance of early venous drainage. However, subsequent precontrast brain CT showed hydrocephalus underwent left ventriculoperitoneal shunt placement. Keywords : Pial arteriovenous fistula, Aneurysm, Cerebral hemorrhage, Angiography, Surgery
Corresponding author : Jianping Gong, gongjianpingsz@126.com