{
  "abstract": "Introduction Pial arteriovenous fistulas (AVFs) are rare intracranial arteriovenous shunts, accounting for approximately 1.6–4.7% of such lesions. They typically present in neonates with congestive heart failure or are diagnosed prenatally. Adult-onset hemorrhagic presentation is extremely rare. We report a case of hemorrhagic pial AVF in an adult patient, originally diagnosed during childhood but left untreatedAbstract C111 Figure 1Case Description A 36-year-old male presented with a seizure and stuporous mentation. He had a remote history of untreated arteriovenous malformation diagnosed in childhood. Brain CT revealed IVH involving the entire ventricular system. CTA demonstrated hypertrophied left ACA, MCA, and PCA, with a large venous pouch. To manage elevated intracranial pressure, bilateral EVD and hematoma aspiration were performed. DSA revealed a pial AVF in the left parietal lobe, directly draining into a venous pouch without a nidus, fed by the left ACA, MCA, and PCA. Endovascular treatment with coil embolization was planned. Due to tortuous arterial anatomy, Phemon 21 catheter enabled successful distal navigation. Coil embolization achieved complete obliteration of the pial AVF. Final angiography showed the disappearance of antegrade left ACA flow and delayed retrograde filling. Postprocedural perfusion CT demonstrated decreased perfusion in the left ACA territory without infarction. The patient was discharged with GCS 8 and MRS 3.Abstract C111 Figure 2Conclusions Untreated pediatric-onset pial AVFs may present with hemorrhagic events in adulthood. In such cases, endovascular access can be challenging due to vascular tortuosity, necessitating careful catheter selection and technique for successful embolization.Conflict of Interest No",
  "authors": [
    {
      "affiliations": [
        "Department of neurosurgery, Gil Medical Center, Gachon University College of Medicine, Incheon, South Korea"
      ],
      "name": "Chanjong Yoo"
    }
  ],
  "title": "C111 Hemorrhagic presentation of an untreated pediatric-onset pial arteriovenous fistula in an adult",
  "uid": "12c801df-4415-5fff-acd5-4be24f132163"
}