Intracranial Pial Arteriovenous Fistula Mimicking a Vein of Galen Aneurysm with Hydrocephalus Managed with Endovascular Method: Case Report

Background and Importance Intracranial pial arteriovenous fistula (IPAVF) is a group of infrequently occurring vascular malformation in children [1-7]. IPAVF represents a subpial vascular malformation with high-flow shunt fed by mostly one or more pial arterial feeders and drainage by a solitary vein and lacking nidus [1,3,4]. Characteristically, these pediatric cases become symptomatic with catastrophic presentations. Thus, early treatment is advised for good neurological outcome. Intracranial pial arteriovenous fistulas can be managed by either endovascular method or direct attack of craniotomy with surgical resection or rarely a combination of procedures [5-7]. Case Presenation A 2-year-old boy was referred to the emergency department with macrocrania and seizures. Eight months before that, his mother had noticed signs which suggested psychomotor development retardation (PDR). His mental status was postictal. The patient had normal vital signs with the physical examination otherwise being unremarkable. Axial computed tomography (CT) scan of the brain without contrast showed hydrocephalus, a hyperdense vein of Galen in the midline and associated enlarged straight sinus. The probable diagnosis could be an aneurysm of the vein of Galen (Figure 1). Magnetic resonance imaging (MRI) was Abstract