Surgical flow disconnection of cerebral pial dual-channel arteriovenous fistula with a large varix: the role of anti-platelet agent or anti-coagulation therapy

• Published in: Child's nervous system Vol. 29; no. 6; pp. 1021 - 1025
• Main Authors: Yang, Jeyul, Kwon, O-Ki, Oh, Chang Wan, Hwang, Gyojun, Song, Kyung Sun, Lee, Young Jin, Bang, Jae Seung
• Format: Journal Article
• Language: English
• Published: Berlin/Heidelberg Springer-Verlag 01.06.2013
• Subjects: Adolescent; Anticoagulants - therapeutic use; Arteriovenous Fistula - drug therapy; Arteriovenous Fistula - pathology; Arteriovenous Fistula - surgery; Case Report; Cerebral Angiography; Embolization, Therapeutic - methods; Follow-Up Studies; Humans; Medicine; Medicine & Public Health; Neurosciences; Neurosurgery; Pia Mater - surgery; Platelet Aggregation Inhibitors - therapeutic use; Tomography, X-Ray Computed; Treatment Outcome; Varicose Veins - surgery; Edema; Pial arteriovenous fistula; Infarction; Varix
• ISSN: 0256-7040; 1433-0350
• DOI: 10.1007/s00381-013-2025-8

Introduction Intracranial pial arteriovenous fistula (AVF) is a rare cerebrovascular lesion, and the literature is sparse. Most authors insist that simple disconnection of arteriovenous shunting is enough to treat intracral single-channel pial AVF in most cases, either by microsurgery or endovascular embolization without resection of entire vascular malformation. Discussion We report an insidious onset of peri-lesional edema formation after abrupt disconnection of AVF shunting with surgical arterial ligation. Treatment entailed anti-platelet and anti-coagulation agent to slow down thrombus formation in intracranial dual-channel pial AVF. We suggest that slowing down thrombus formation in the large varix with anti-platelet and/or anti-coagulation agents seems to be necessary in case of abrupt disconnection of shunting in intracranial single- or dual-channel pial AVF to prevent postoperative cerebral edema or infarction.