Endovascular therapy of a craniocervical pial AVF fed by the anterior spinal artery.

Though pial arteriovenous fistulae (PAVF) are an uncommon cerebrovascular disorder, their presentation with subarachnoid hemorrhage (SAH) is not rare. PAVF near the craniocervical junction are rare and may have a worse outcome. These fistulae are often fed from either the carotid and/or the vertebrobasilar systems, but are rarely fed by the anterior spinal artery. We report the case of a young man presenting with SAH. Cerebral angiography revealed 2 AVF, a symptomatic PAVF located at the craniocervical junction and fed from the anterior spinal artery and incidental dural AVF (DAVF) originate from the left occipital and middle meningeal arteries. These fistulae were treated with different endovascular techniques, including Onyx and platinum coil embolization into the feeding arteries of the DAVF and PAVF, respectively.