A Case of Pial Arteriovenous Fistulae Associated with Hereditary Hemorrhagic Telangiectasia
Pial arteriovenous fistulae(pial AVF)are rare vascular lesions. Pial AVF is a complication of hereditary hemorrhagic telangiectasia(HHT)and is associated with a high mortality rate. Here, we report a case of a 14-year-old boy with pial AVF associated with HHT who presented with a seizure. CT and MRI showed enlarged vessels with venous varices in the Sylvian fissure. Digital subtraction angiography(DSA)revealed a pial AVF with a single feeder originating from the middle cerebral artery with large varicose venous drainage, which drained into the transverse sinus, and superior sagittal sinus. A transarterial coil embolization was performed. During the procedure, flow control by a balloon guiding catheter was used. The patient had no neurological deficits after treatment. However, while microsurgery or endovascular treatment are the primary treatment options for pial AVF, there is no consensus regarding their efficacy. Using a balloon guiding catheter to control flow is useful for the treatment of pial AVF with a high-flow shunt.