fistula_arteriovenosa_pial

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Fístula arteriovenosa pial

Es una lesion vascular cerebral, reconocida como anomalía vascular diferente dentro de la malformacion arteriovenosa cerebral.

Difieren de las malformaciones arteriovenosas, que no tienen nido, y se componen de uno o más arterias nutricias con una sola vena de drenaje.

Muchos de ellos tienen asociado una variz venosa o aneurisma venoso gigante.

Se diferencian de las fístulas arteriovenosas durales en que las arterias aferentes son piales y no se encuentra englobadas dentro de la duramadre.

Epidemiología

Constituyen el 1,6% de las malformaciones vasculares cerebrales.

Hasta un 25% presentan asociación con la telangiectasia hemorrágica hereditaria.

En una revisión de 7 pacientes pediátricos, la edad media fue de 4,2 años. La presentación clínica más frecuente fue la insuficiencia cardiaca.

Dos pacientes tenían una mutación del gen RASA1, asociado a un síndrome vascular hereditario.

El tratamiento endovascular combinado con la cirugía fué el tratamiento más frecuentemente empleado (Walcott y col., 2012).

Localización

Las intracraneales son más frecuentes que las espinales.

Bibliografía

Walcott, Brian P, Edward R Smith, R Michael Scott, and Darren B Orbach. 2012. “Pial arteriovenous fistulae in pediatric patients: associated syndromes and treatment outcome.” Journal of Neurointerventional Surgery (January 2). doi:10.1136/neurintsurg-2011-010168. http://www.ncbi.nlm.nih.gov/pubmed/22213836.

Bibliografía recomendada

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34: Oishi M, Sasaki O, Nakazato S, Suzuki K, Kitazawa K, Takao T, Koike T. Unusual giant cerebral venous varix associated with brain abscess: variant of hereditary hemorrhagic telangiectasia–case report. Neurol Med Chir (Tokyo). 2007 Feb;47(2):74-8. PubMed PMID: 17317945.

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39: Perini S, Zampieri P, Rosta L, Piovan E, Micheli ED, Nicolato A, Mazza C, Benati A, Ruatti P. Endovascular treatment of pial AVMs: technical options, indications and limits in pediatric age patients. J Neurosurg Sci. 1997 Dec;41(4):325-30. PubMed PMID: 9555638.

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56: Weon YC, Yoshida Y, Sachet M, Mahadevan J, Alvarez H, Rodesch G, Lasjaunias P. Supratentorial cerebral arteriovenous fistulas (AVFs) in children: review of 41 cases with 63 non choroidal single-hole AVFs. Acta Neurochir (Wien). 2005 Jan;147(1):17-31; discussion 31. PubMed PMID: 15614467.

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60: Youn SW, Han MH, Kwon BJ, Kang HS, Chang HW, Kim BS. Coil-based endovascular treatment of single-hole cerebral arteriovenous fistulae: experiences in 11 patients. World Neurosurg. 2010 Jan;73(1):2-10; discussion e1. Epub 2009 Aug 7. PubMed PMID: 20452863.

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