A Case of Childhood Aymptomatic Pial Arteriovenous Fistula

A 10-year-old boy presented with frontalgia associated with sinusitis. He was cured by oral antibiotics, but neuroradiological examination showed pial arteriovenous fistula with a huge varix. The feeding arteries were the dilated left middle cerebral arteries and there were no angiographical findings that indicated a nidus and capillary network. Two dilated draining veins flowed through the varix and drained the superior sagittal sinus and left transverse sinus. The patient underwent left fronto-temporo-parietal craniotomy. We surgically resected pial AVF with a varix under intra- and post-operative mild barbiturate anesthesia. Postoperative angiography demonstrated that the arteriovenous shunt was completely resected. The patient no longer presented any neurological deterioration. There were only four cases of presented aymptomatic pial AVF in the literature. The issue of how we treat the asymptomatic cases of pial AVF is controversial. We provide a case presentation and review the literature.