PMC4476140_01
Preoperative angiography of a PAVF with associated aneurysms. (a) 3D angiography showing a PAVF fed by a branch of the anterior cerebral artery with draining from the frontal basal vein (arrow). Aneurysms in the internal carotid artery at the origin of the posterior communicating artery and anterior choroidal arteries and a pericallosal aneurysm. (b) Oblique view of the angiography showing a PAVF. (c) Side view of the angiography in arterial phase showing a PAVF fed by the anterior cerebral artery. (d) Side view of the angiography in venous phase showing dilated frontal basal vein due to a PAVF. (e) 3D angiography showing aneurysm of the anterior communicating artery
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F1
The cerebral digital subtraction angiography showed a PAVF fed by a dilated branch of the right anterior cerebral artery, draining from the frontal basal vein to the sphenoparietal sinus and dilation of the frontal basal vein [Figure 1]. There were also small aneurysms in the anterior communicating artery, the pericalosa artery, and two aneurysms in the right internal carotid artery and at the origin of the posterior communicating and anterior choroidal arteries [Figure 1].
Surgical picture of a PAVF. (a) The fistulous communication between the anterior cerebral artery and frontal basal vein (Yellow Arrow). (b and c) The occlusion of the arteriovenous shunt with an aneurysm clip. (d) The occlusion of the arteriovenous shunt and pericalosa aneurysm
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F2
The fistula and aneurismatic dilation were occluded with clips [Figure 2].
Postoperative angiography showing complete exclusion of a PAVF. (a) Side view of the angiography in arterial phase. (b) Side view of the angiography in cortical phase
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F3
Polymyxin E for 14 days. Postoperative angiographic revealed a complete obliteration of the fistula [Figure 3].
PMC4476140_02
(a) Brain CT showing a right frontal temporal cortical hipotrophy and extensive vascular dilation in the right anterior frontal region. (b) Cerebral angiography showing a PAVF in the anterior frontal region fed by a branch of the right middle cerebral artery and drained by the swollen Trolard vein with large venous aneurysm
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F4
AVM [Figure 4a]. Cerebral angiography showed a PAVF in the anterior frontal region, fed by a branch of the right middle cerebral artery, which drains into the Trolard vein. A large variceal dilatation of the proximal venous and was noted in association with the PAVF [Figure 4b].
Surgical Picture of a PAVF. (a) Dilation of the middle cerebral artery in direct communication with venous system (yellow arrow). (b) The surgical clipping of the feeding artery and the resection of the venous dilation
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F5
Resection of variceal dilatation was also performed due to mass effect [Figure 5].