Abstract

Pediatric nongalenic pial AVFs are extremely uncommon and endovascular embolization is the preferred treatment option for these lesions at many centers. Endovascular embolization is extremely expensive in developing countries. Excellent outcomes and high cure rates have been reported with microsurgery for pial AVFs and is a cost effective treatment option compared to endovascular embolization in developing countries. Successful surgical management of a pediatric temporal pial AVF is described in this report supplemented with operative video of the case. A 17 yrs old boy presented with history of head ache and left hemiparesis for past 6 months. MR imaging revealed a large flow void in the right temporal region with mass effect. DSA revealed a large pial AVF with a large feeder from MCA and drainage into superior sagittal sinus and transverse sinus. Right frontotemporal craniotomy and excision of pial AVF was performed. Postoperative course was uneventful. Postoperative DSA revealed complete excision of AVF. Left hemiparesis gradually improved after surgery and at a follow-up of 7 months child was asymptomatic with no neurological deficits.

Key words: endovascular embolization, microsurgery for pial AVFs, pediatric pial AVFs, steal phenomenon, venous varix