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Intracranial pial fistulas in pediatric population. Clinical features and treatment modalities

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The purpose of the study is to describe the clinical manifestations and treatment modalities of patients having intracranial pial arteriovenous fistulas (PAVFs).


We retrospectively analyzed the cases of PAVFs from January 2004 to December 2013. Medical charts, diagnostic images, surgical, and endovascular reports were reviewed retrospectively during each of the procedures and follow-up. We recorded patient demographics, clinical presentation, treatment modalities, and outcome.


Ten patients with single PAVFs were identified, one of them with multiple holes. The median age was 7.5 years old (20 days to 14 years). Six patients were male (60 % of cases). Four PAVFs were localized in the posterior fossa, and six were supratentorial (60 %). Two patients had intracranial bleeding, three presented seizures, one was studied for chronic headaches, three manifested by growth retardation, one had hydrocephalus, and one had a congestive heart failure (CHF) and vein of Galen aneurysmal malformation (VGAM). The latter did not improve after embolization and died few days later. Endovascular therapy was used in eight, whereas two patients were surgically managed. Total occlusion of the fistula was achieved in all cases.


PAVF affects pediatric population at different ages with miscellaneous clinical manifestations. Endovascular treatment is safe and effective when the venous side of the fistula can be occluded.

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  1. Hetts SW, Keenan K, Fullerton HJ, Young WL, English JD, Gupta N, Dowd CF, Higashida RT, Lawton MT, Halbach VV (2012) Pediatric intracranial nongalenic pial arteriovenous fistulas: clinical features, angioarchitecture, and outcomes. AJNR Am J Neuroradiol 33:1710–1719

    Article  CAS  PubMed  Google Scholar 

  2. Kraneburg UM, Nga VD, Ting EY, Hui FK, Lwin S, Teo C, Chou N, Yeo TT (2013) Intracranial pial arteriovenous fistula in infancy: a case report and literature review. Childs Nerv Syst ChNS Off J Int Soc Pediatr Neurosurg 30(2):365–369

    Article  Google Scholar 

  3. Lasjaunias P, ter Brugge KG, Berenstein A (2006) Cerebral arteriovenous fistulas. In: Lasjaunias P, ter Brugge KG, Berenstein A (eds) Surgical neuroangiography, vol 3, 2nd edn. Springer-Verlag, Berlin, pp 227–289

    Chapter  Google Scholar 

  4. Madsen PJ, Lang SS, Pisapia JM, Storm PB, Hurst RW, Heuer GG (2013) An institutional series and literature review of pial arteriovenous fistulas in the pediatric population: clinical article. Neurosurg Pediatr 12(4):344–350. doi:10.3171/2013.6.PEDS13110

    Article  Google Scholar 

  5. Nelson PK, Nimmy Y, Lasjaunias P et al (1999) Endovascular embolization of congenital intracranial pial arteriovenous fistulas. Neuroimaging Clin N Am 2:309–317

    Google Scholar 

  6. Nesbit GM, Barnwell SL (1998) The use of electrolytically detachable coils in treating high-flow arteriovenous fistulas. AJNR Am J Neuroradiol 19:1565–1569

    CAS  PubMed  Google Scholar 

  7. Nishiyama Y, Kanemaru K, Yoshioka H, Hanihara M, Horikoshi T, Kinouchi H (2013) Intracranial pial arteriovenous fistula caused by dural tenting: case report. Neurol Med Chir. doi:10.2176/nmc.cr2012-0239

    Google Scholar 

  8. Panigrahi S, Mishra SS, Das S, Parida DK (2013) Intracerebral pial arteriovenous fistula with large venous varix: a rare case report. Surg Neurol Int 4:22

    Article  PubMed Central  PubMed  Google Scholar 

  9. Paramasivam S, Toma N, Niimi Y, Berenstein A (2013) Development, clinical presentation and endovascular management of congenital intracranial pial arteriovenous fistulas. J Neurointerv Surg 5:184–190

    Article  PubMed  Google Scholar 

  10. Phatouros CC, Halbach VV, Dowd CF, Lempert TE, Malek AM, Meyers PM, Higashida RT (1999) Acquired pial arteriovenous fistula following cerebral vein thrombosis. Stroke 30:2487–2490

    Article  CAS  PubMed  Google Scholar 

  11. Saito A, Sugawara T, Mikawa S, Akamatsu Y, Saito H, Seki H (2008) A case of multiple pial arteriovenous fistulas associated with dural arteriovenous fistula. Case report. J Neurosurg 109:1103–1107

    Article  PubMed  Google Scholar 

  12. Sugimoto T, Park YS, Nakagawa I, Nishimura F, Motoyama Y, Nakase H (2015) Effectiveness of intraoperative indocyanine green videoangiography in direct surgical treatment of pediatric intracranial pial arteriovenous fistula. J Neurosurg Pediatr 15(1):55–59. doi:10.3171/2014.9.PEDS13683

    Article  PubMed  Google Scholar 

  13. Tomlinson FH, Rüfenacht DA, Sundt TM Jr, Nichols DA, Fode NC (1993) Arteriovenous fistulas of the brain and the spinal cord. J Neurosurg 79:16–27

    Article  CAS  PubMed  Google Scholar 

  14. Weon YC, Yoshida Y, Sachet M, Mahadevan J, Alvarez H, Rodesch G, Lasjaunias P (2005) Supratentorial cerebral arteriovenous fistulas (AVFs) in children: review of 41 cases with 63 nonchoroidal single-hole AVF. Acta Nerochir 147:17–31

    Article  CAS  Google Scholar 

  15. Yang WH, Shian Lu M, Cheng YK, Chung Wang T (2011) Pial arteriovenous fistula: a review of literature. Br J Neurosurg 25(5):580–585

    Article  PubMed  Google Scholar 

  16. Yoshida Y, Weon YC, Sachet M, Mahadevan J, Alvarez H, Rodesch G, Lasjaunias P (2004) Posterior cranial fossa single-hole arteriovenous fistulae in children: 14 consecutive cases. Neuroradiology 46:474–481

    Article  CAS  PubMed  Google Scholar 

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Correspondence to Flavio Requejo.

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Requejo, F., Jaimovich, R., Marelli, J. et al. Intracranial pial fistulas in pediatric population. Clinical features and treatment modalities. Childs Nerv Syst 31, 1509–1514 (2015).

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