PMC4533426_01
A, B: Preoperative cerebral angiography showed a right middle cerebral artery (MCA) aneurysm projecting laterally, but no other vascular anomalies. C, D: Postoperative cerebral angiography revealed an arteriovenous fistula (black arrow) fed by the right MCA and drained through the Sylvian vein into the vein of Trolard (white arrows). E: The fistulous point was located just beneath the dural tenting (black arrow). F: Postoperative cerebral angiography revealed no shunting (black arrow).
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F1
Cerebral angiography showed a right middle cerebral artery (MCA) aneurysm, but no other vascular anomalies (Fig. 1A, B). Cerebral angiography performed two weeks after the surgery revealed a vascular anomaly fed by the right MCA and drained through the Sylvian vein into the vein of Trolard (Fig. 1C, D). The lesion was located dural tenting of the previous surgery (Fig. 1E). Postoperative CT showed no abnormality, and cerebral angiography revealed the occlusion of the fistula (Fig. 1F).
A: The dura matter over the lesion was dark reddish in color (black arrow). B: The dura was slightly adhered to the arachnoid membrane around the fistulous point (black arrow). C: After dural opening, the fistulous point (black arrow) and red vein (white arrow heads) was exposed. D: Fluorescein video angiography revealed early venous filling of the Sylvian vein (white arrow heads). E: After the fistulous point was clipped, the red vein normalized (white arrow heads). F: Disappearance of early venous filling (white arrow heads) and disconnection of the shunting was confirmed with fluorescein video angiography.
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F2
The dura matter over the lesion was dark reddish in color (Fig. 2A). The dura was slightly adhered to the arachnoid membrane around the fistulous point (Fig. 2B). After dural opening, the fistulous point and red vein was exposed (Fig. 2C). Fluorescein video angiography revealed early venous filling of the Sylvian vein (Fig. 2D). The fistulous point was clipped and the obliteration was confirmed with fluorescein video angiography (Fig. 2E, F).