PMC4663025_01
Magnetic resonance (MR) imaging (left) and MR angiography (right) obtained on admission. There was mild brain edema; however, no abnormal vessels were observed.
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F1
Magnetic resonance imaging (MRI) exhibited brain edema in the right temporal lobe, and magnetic resonance (MR) angiography was normal (Fig. 1).
Magnetic resonance (MR) imaging (left) and MR angiography (right) obtained 7 days after the onset. Brain edema worsened, and an abnormal vessel appeared in the right cerebrum (arrow).
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F2
MRI revealed that the brain edema at the right temporal lobe worsened, and that an abnormal vein around the contusion of the temporal lobe appeared (Fig. 2).
Angiography on the arterial phase (left) and on the capillary phase (right). A pial arteriovenous fistula was fed by the branch of the right middle cerebral artery, and draining to the vein of Labbe. On the capillary phase, the sylvian vein was visible by the back flow from the vein of Labbe.
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F3
Subsequent angiograms demonstrated a pial AVF, fed by the branch of the middle cerebral artery and draining into the vein of Labbe (Fig. 3).
Intraoperative photographs. The feeding artery was identified (left), and was clipped near the fistula (middle). The fistula was coagulated (right).
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F4
The artery was clipped just proximal to the fistula, and the fistula was coagulated (Fig. 4).