• Alessandro Pedicelli, Marta Iacobucci, Paolo Frassanito, Emilio Lozupone, Gabriele Masselli, Concezio Di Rocco, and Cesare Colosimo.
• Department of Radiology, Catholic University of Sacred Heart, Fondazione Policlinico Universitario A. Gemelli, Rome, Italy.
• World Neurosurg. 2017 Aug 1; 104: 1050.e13-1050.e18.

BackgroundIntracranial pial arteriovenous fistulas (PAVFs) are direct communications between the arterial and venous system of the brain, with the characteristic absence of a plexiform nidus, as seen in the classic cerebral arteriovenous malformations. These vascular malformations, usually occurring in the pediatric population, very rarely are diagnosed in utero, because of a lack of understanding of the condition and because they may be hard to visualize.Case DescriptionWe report a rare case of a mass-effect PAVF diagnosed with fetal magnetic resonance imaging, involving the right cerebral hemisphere, fed by a pericallosal artery and associated with a giant venous dilatation. The PAVF initially was managed by the endovascular embolization. The recruitment of a middle cerebral artery feeder and the rapidly enlarging size of the venous pouch with mass effect required subsequent surgery.ConclusionsThe 2-stage multimodal treatment resulted in complete disappearance of the PAVF without complications.Copyright © 2017 Elsevier Inc. All rights reserved.

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