Journal of Cerebrovascular and Endovascular Neurosurgery

Korean Society of Cerebravascular Surgeons (대한뇌혈관외과학회)
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Iatrogenic mixed pial and dural arteriovenous fistula after pterional approach for surgical clipping of aneurysm: A case report

  • Seung-Bin Woo (Department of Neurosurgery, Dongsan Medical Center, Keimyung University School of Medicine) ;
  • Young San Ko (Department of Neurosurgery, Dongsan Medical Center, Keimyung University School of Medicine) ;
  • Chang-Young Lee (Department of Neurosurgery, Dongsan Medical Center, Keimyung University School of Medicine)
  • Received : 2022.12.25
  • Accepted : 2023.04.23
  • Published : 2023.12.31
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Abstract

Craniotomy is known as a cause of iatrogenic dural cerebral arteriovenous fistula (AVF). However, mixed pial and dural AVFs after craniotomy are extremely rare and require accurate diagnosis and prompt treatment due to their aggressiveness. We present a case of an iatrogenic mixed pial and dural AVF diagnosed 2 years after pterional craniotomy for surgical clipping of a ruptured anterior choroidal aneurysm. The lesion was successfully treated using single endovascular procedure of transvenous coil embolization through the engorged vein of Labbe and the superficial middle cerebral vein. The possibility of the AVF formation after the pterional approach should always be kept in mind because it usually occurs at the middle cranial fossa, which frequently has an aggressive nature owing to direct cortical venous or leptomeningeal drainage patterns. This complication is believed to be caused by angiogenetic conditions due to coagulation, retraction, and microinjuries of the perisylvian vessels, and can be prevented by performing careful sylvian dissection according to patient-specific perisylvian venous anatomy.

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References

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