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Microsurgical division of an arteriovenous fistula within the sylvan fissure

This is part of a series of teaching videos for medical students and neurosurgery trainees at Queens Hospital, Romford, UK. Pial arteriovenous fistulae are rare neurovascular lesions characterised by a single or multiple arteries directly shunting into a cortical vein without the presence of a nidus. The arteries are not durally based, instead they are branches that fistulate with the vein via the pia. This is an unusual case of a patient presenting with otalgia associated with a pulsatile tinnitus. MRI and angiography revealed a Cognard grade IV AVF within the sylvan fissure with a high risk of intracranial haemorrhage. This video describes the history, imaging findings, treatment options and description of the surgery and anatomy.

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With our head office located in Northampton, we have access to a network of clinic locations throughout the UK.

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The Spine MDT Ltd

1 Rushmills
Bedford Road

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BMI - London Independent Hospital
1 Beaumont Square, London, E1 4NL

BMI - Chelsfield Park Hospital
Private Consultations and Surgery
Bucks Cross Rd, Chelsfield, Orpington, BR6 7RG

Spire - Hartswood Brentwood
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Eagle Way, Warley, Brentwood, CM13 3LE