Embolization of Cerebral Pial Arteriovenous Fistula Under Balloon-assisted Flow Control Using NBCA: a Case Report

rare vascular lesions of the brain. These lesions differ from arteriovenous malformation (AVMs) as they are direct artery to vein connections, have no nidus, and are composed of one or more direct arterial feeders with a single draining vein. Many of these have associated venous varix or giant venous aneurysms (1). Owing to the absence of a nidus, closure of the shunt by either endovascular or surgical technique represents a satisfactory therapeutic procedure (2). Endovascular treatment offers a simple and safe option. We present a case of a 29-year-old man with a pial AVF of the left cerebral hemisphere, which was fed by the left middle cerebral artery and was associated with large saccular venous dilation and continuous varicose venous dilatations. We successfully occluded the fistula using endovascular glue embolization in association with balloon occlusion in the afferent artery to slow down the flow within the fistula.