• Jingwei Li, Zeng Gao, Xinglong Zhi, Jianxin Du, Hongqi Zhang, and Feng Ling.
• Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, China.
• World Neurosurg. 2018 Sep 1; 117: 292-297.

BackgroundIntracranial pial arteriovenous fistulas (PAVFs) are rare cerebrovascular lesions with high mortality rates. We report a rare case of pediatric PAVF at the basilar artery tip and its treatment with surgical clipping aided by a trapping-evacuation technique in a hybrid operating room.Case DescriptionAn 18-month-old boy was admitted with hypoevolutism and 4-month history of weakness in the left extremities. Magnetic resonance imaging showed a giant aneurysm-like malformation in the area of midbrain and pons. Angiography showed a high-flow PAVF fed by the basilar artery and bilateral P1 segments of the posterior cerebral artery, with deep draining veins into the transverse sinus and straight sinus. Given the intrinsic characteristics of the lesion, such as deep location, giant fistula and varix, and multiple feeding arteries, clipping of PAVF was performed in a hybrid operating room aided by a trapping-evacuation technique to clearly identify and block the shunting point.ConclusionsThe successful obliteration of the lesion is reported. In addition, a brief review of literature comparing endovascular embolization, surgical disconnection, and hybrid technique for treatment of PAVF is included.Copyright © 2018 Elsevier Inc. All rights reserved.

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