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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.

In addition to face-to-face appointments, we also offer remote video consultations. Many hospitals have set up secure video consultation access via popular video platforms such as MS Teams or Zoom, and if required the appointment staff can help you to set up these consultations.

Head Office

The Spine MDT Ltd

1 Rushmills
Bedford Road
Northampton
NN4 7YB

Primary Clinic Locations

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

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

Essex
Spire - Hartswood Brentwood
Private Consultations and Surgery
Eagle Way, Warley, Brentwood, CM13 3LE