Endovascular embolization of pial arteriovenous fistula fed from P1 segment of posterior cerebral artery in 12 years old girl: Case report and review of literature

Objective: Intracranial pial arteriovenous fistulas (PAVFs) are rare vascular lesions with peculiar epidemiological, morphological, and pathophysiological characteristics. Since there is no nidus, PAVF treatment has been performed by direct disconnection of the arteriovenous communication via a surgical, endovascular, or a combined approach. We aim to outline the relevant variables to consider in planning an endovascular treatment strategy. Methods: We present a case of a 12 year old girl with a single feeder PAVF originating from the first segment (P1) of the left posterior cerebral artery with a varicose venous drainage into the right cavernous sinus. Results: We report the successful endovascular exclusion of the fistula with the release of a total of 27 detachable platinum coils with no complications at follow-up. Treatment strategy and nuances are discussed along with a review of the literature. Conclusions: Morphology, age, embolization strategies, and materials are the different variables to be analyzed in the endovascular treatment of such lesions.