Asian Journal of Neurosurgery

CASE REPORT
Year
: 2020  |  Volume : 15  |  Issue : 1  |  Page : 176--179

Anterior cranial fossa dural arteriovenous fistula with pial arterial supply


Akinari Yamano1, Kazuhiro Nakamura3, Daisuke Watanabe2, Kuniyuki Onuma4, Masayuki Sato2, Yuji Matsumaru2, Kiyoyuki Yanaka4, Eiichi Ishikawa2, Akira Matsumura2 
1 Department of Neurosurgery, Faculty of Medicine, University of Tsukuba; Department of Neurosurgery, Tsukuba Memorial Hospital, Tsukuba City, Ibaraki, Japan
2 Department of Neurosurgery, Faculty of Medicine, University of Tsukuba, Tsukuba City, Ibaraki, Japan

Correspondence Address:
Dr. Eiichi Ishikawa
Department of Neurosurgery, Faculty of Medicine, University of Tsukuba, Tsukuba City, Ibaraki
Japan

Anterior cranial fossa (ACF) dural arteriovenous fistulas (DAVFs) are mainly fed by the ethmoidal arteries and sometimes have pial arterial feeders. DAVFs with pial arterial supply in ACF are extremely rare because most of the reported cases of DAVFs with pial arterial supply are located at the transverse sigmoid sinus and tentorium. A 68-year-old male presented with dizziness. Angiography showed cortical venous reflex (CVR) through an ACF DAVF fed by both bilateral ethmoidal arteries and by the right orbitofrontal artery as a pial feeder. The ethmoidal feeders were disconnected by craniotomy. The pial arterial feeder from the anterior cerebral artery was not found during surgery, and disconnection of the draining vein was not performed. CVR showed a significant reduction after the surgery. After 2 years of follow-up, angiography revealed an increased shunt flow from the pial feeder. Endovascular treatment using n-butyl-2-cyanoacrylate was performed, resulting in the complete occlusion of the fistula. DAVFs with pial supply are reported to carry a high risk of perioperative complications because of the restriction of the venous outflow and retrograde thrombosis of the pial artery. Endovascular pial feeder occlusion after surgical dural arterial feeder disconnection might achieve a safe and effective outcome. With close follow-up, the recurrence of increased shunt flow may be an appropriate timing for additional treatment. This rare condition may offer a new insight into the mechanisms of pial feeder development.


How to cite this article:
Yamano A, Nakamura K, Watanabe D, Onuma K, Sato M, Matsumaru Y, Yanaka K, Ishikawa E, Matsumura A. Anterior cranial fossa dural arteriovenous fistula with pial arterial supply.Asian J Neurosurg 2020;15:176-179


How to cite this URL:
Yamano A, Nakamura K, Watanabe D, Onuma K, Sato M, Matsumaru Y, Yanaka K, Ishikawa E, Matsumura A. Anterior cranial fossa dural arteriovenous fistula with pial arterial supply. Asian J Neurosurg [serial online] 2020 [cited 2020 Aug 4 ];15:176-179
Available from: http://www.asianjns.org/article.asp?issn=1793-5482;year=2020;volume=15;issue=1;spage=176;epage=179;aulast=Yamano;type=0