Venous varix enlargement after cerebrospinal fluid diversion in a neonate with pial arteriovenous fistula complicated with hydrocephalus. A case report
Background: Neonatal intracranial pial arteriovenous fistulas (AVFs) are rare vascular malformations. The pathophysiology of hydrocephalus in cases of pial AVF remains to be fully understood. Here, authors report a case of pial AVF with a large venous varix, which rapidly expanded after cerebrospina...
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2021-03-01
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doaj-394a18d9d5d246d5913d6daf8a7b31a82020-12-15T04:10:14ZengElsevierInterdisciplinary Neurosurgery2214-75192021-03-0123100981Venous varix enlargement after cerebrospinal fluid diversion in a neonate with pial arteriovenous fistula complicated with hydrocephalus. A case reportKenichi Sato0Masayuki Ezura1Tomomi Kimiwada2Teiji Tominaga3Department of Neurosurgery, Tohoku Medical and Pharmaceutical University, Sendai, JapanDepartment of Neurosurgery, NHO Sendai Medical Center, Sendai, Japan; Corresponding author at: Department of Neurosurgery, NHO Sendai Medical Center, 2-11-12, Miyagino, Miyagino-Ku, Sendai 983-8520, Japan.Department of Neurosurgery, Miyagi Children’s Hospital, Sendai, JapanDepartment of Neurosurgery, Tohoku University Graduate School of Medicine, Sendai, JapanBackground: Neonatal intracranial pial arteriovenous fistulas (AVFs) are rare vascular malformations. The pathophysiology of hydrocephalus in cases of pial AVF remains to be fully understood. Here, authors report a case of pial AVF with a large venous varix, which rapidly expanded after cerebrospinal fluid (CSF) diversion. Case description: A female neonate was born at full term following a normal pregnancy and delivery. A supracerebellar pial AVF with a large venous varix and the hydrocephalus due to complex mechanism were found on fetal imaging. She had no neurological deficits, but her head circumference was slightly larger than normal. The hydrocephalus was treated via CSF diversion, but this was followed by a remarkable expansion of the venous varix. Transarterial embolization of the AVF was subsequently performed, which resulted observable improvement of the hydrocephalus. Conclusion: Hydrocephalus complicating pial AVFs with a venous varix should not be treated by CSF diversion first. Instead, the initial step in the treatment should be obliteration of the AVFs. This restores the hydrodynamic balance between the CSF and intracranial venous system, resulting in the gradual improvement of the hydrocephalus.http://www.sciencedirect.com/science/article/pii/S2214751920305429Endovascular treatmentHydrocephalusPial arteriovenous fistula |
collection |
DOAJ |
language |
English |
format |
Article |
sources |
DOAJ |
author |
Kenichi Sato Masayuki Ezura Tomomi Kimiwada Teiji Tominaga |
spellingShingle |
Kenichi Sato Masayuki Ezura Tomomi Kimiwada Teiji Tominaga Venous varix enlargement after cerebrospinal fluid diversion in a neonate with pial arteriovenous fistula complicated with hydrocephalus. A case report Interdisciplinary Neurosurgery Endovascular treatment Hydrocephalus Pial arteriovenous fistula |
author_facet |
Kenichi Sato Masayuki Ezura Tomomi Kimiwada Teiji Tominaga |
author_sort |
Kenichi Sato |
title |
Venous varix enlargement after cerebrospinal fluid diversion in a neonate with pial arteriovenous fistula complicated with hydrocephalus. A case report |
title_short |
Venous varix enlargement after cerebrospinal fluid diversion in a neonate with pial arteriovenous fistula complicated with hydrocephalus. A case report |
title_full |
Venous varix enlargement after cerebrospinal fluid diversion in a neonate with pial arteriovenous fistula complicated with hydrocephalus. A case report |
title_fullStr |
Venous varix enlargement after cerebrospinal fluid diversion in a neonate with pial arteriovenous fistula complicated with hydrocephalus. A case report |
title_full_unstemmed |
Venous varix enlargement after cerebrospinal fluid diversion in a neonate with pial arteriovenous fistula complicated with hydrocephalus. A case report |
title_sort |
venous varix enlargement after cerebrospinal fluid diversion in a neonate with pial arteriovenous fistula complicated with hydrocephalus. a case report |
publisher |
Elsevier |
series |
Interdisciplinary Neurosurgery |
issn |
2214-7519 |
publishDate |
2021-03-01 |
description |
Background: Neonatal intracranial pial arteriovenous fistulas (AVFs) are rare vascular malformations. The pathophysiology of hydrocephalus in cases of pial AVF remains to be fully understood. Here, authors report a case of pial AVF with a large venous varix, which rapidly expanded after cerebrospinal fluid (CSF) diversion. Case description: A female neonate was born at full term following a normal pregnancy and delivery. A supracerebellar pial AVF with a large venous varix and the hydrocephalus due to complex mechanism were found on fetal imaging. She had no neurological deficits, but her head circumference was slightly larger than normal. The hydrocephalus was treated via CSF diversion, but this was followed by a remarkable expansion of the venous varix. Transarterial embolization of the AVF was subsequently performed, which resulted observable improvement of the hydrocephalus. Conclusion: Hydrocephalus complicating pial AVFs with a venous varix should not be treated by CSF diversion first. Instead, the initial step in the treatment should be obliteration of the AVFs. This restores the hydrodynamic balance between the CSF and intracranial venous system, resulting in the gradual improvement of the hydrocephalus. |
topic |
Endovascular treatment Hydrocephalus Pial arteriovenous fistula |
url |
http://www.sciencedirect.com/science/article/pii/S2214751920305429 |
work_keys_str_mv |
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