title: Intracerebral pial arteriovenous fistula with large venous varix: A rare case report.
abstract: BACKGROUND
  Intracerebral pial arteriovenous fistulas (AVFs) are rare vascular lesions of the brain. These lesions are composed of one or more direct arterial connection to a single venous channel without true intervening nidus and usually have associated venous varix or giant venous aneurysms. Intracerebral varices are occasionally associated with high-flow AVF, and usually treated by interrupting the feeding arteries leaving the varices intact.
  
  
  METHODS
  We report a rare case of a 24-year-old male with a single-channel pial AVF of the left cerebral hemisphere, which was fed by the left anterior cerebral artery (ACA) and was associated with large venous varix and continuous varicose venous dilatation. This superficially located varix was over 6 cm in diameter posing significant mass effect and had calcified walls. Direct surgical flow disconnection followed by removal of large varix resulted in complete disappearance of pial AVF without complication.
  
  
  CONCLUSIONS
  Though endovascular occlusion of feeding arteries offers a simple and safe option, direct surgical removal should be considered in rare cases of intracerebral superficially located large AVF with calcified wall and mass effect.
authors.affiliation: Department of Neurosurgery, S.C.B. Medical College and Hospital, Cuttack, Odisha, India.
authors.forename: Souvagya
authors.initials: S
authors.lastname: Panigrahi
authors.forename: Sudhansu S
authors.initials: SS
authors.lastname: Mishra
authors.forename: Srikant
authors.initials: S
authors.lastname: Das
authors.forename: Deepak K
authors.initials: DK
authors.lastname: Parida
keywords: Direct surgical removal; Intracerebral pial arteriovenous fistulas; large venous varix; left anterior cerebral artery