title: Infratentorial Pial Arteriovenous Fistula in the Elderly.
abstract: BACKGROUND
  Intracranial pial arteriovenous fistulas (pAVFs) are rare vascular lesions, which may present with, but are distinct from arteriovenous malformation and dural arteriovenous fistula. They most often manifest during infancy or early childhood, but rarely in adulthood.
  
  
  METHODS
  We report an exceptionally rare case of infratentorial pAVF in a 73-year-old man, who presented with progressive gait disturbance due to cerebellar edema resulting from arteriovenous shunts.
  
  
  RESULTS
  The patient was successfully treated by endovascular flow reduction followed by surgical extirpation of the fistula. The diagnosis was confirmed by pathological findings.
  
  
  CONCLUSIONS
  Pial arteriovenous fistula is rare, but can occur in the elderly. Combination of endovascular flow reduction and surgical disconnection yielded an excellent clinical outcome.
authors.affiliation: Department of Neurosurgery, Eiju General Hospital, Higashi-Ueno, Taito-ku, Tokyo, Japan. Electronic address: ryuryukanai@gmail.com.
authors.forename: Ryuichi
authors.initials: R
authors.lastname: Kanai
authors.affiliation: Department of Neurosurgery, Eiju General Hospital, Higashi-Ueno, Taito-ku, Tokyo, Japan.
authors.forename: Jun
authors.initials: J
authors.lastname: Shinoda
authors.affiliation: Department of Pathology, Eiju General Hospital, Higashi-Ueno, Taito-ku, Tokyo, Japan.
authors.forename: Seiya
authors.initials: S
authors.lastname: Akatsuka
mesh_terms: D000368:Aged; D001164:Arteriovenous Fistula / Q000150:complications / Q000473:pathology*; D002531:Cerebellum / Q000473:pathology*; D002533:Cerebral Angiography; D006801:Humans; D008297:Male; D014057:Tomography, X-Ray Computed
keywords: Pial arteriovenous fistula; coil embolization; elderly patients; infratentorial arteriovenous fistula; suboccipital transtentorial approach