A 15-year-old boy of Aashram School was brought to medical casualty by a teacher during midnight in a very bad condition. He had headache, vomiting prior to loss of consciousness as narrated by his teacher. Patient was immediately attended to by the medical team and patient was advised CT Head. The CT scan revealed he had a tumour. The docs at GMCH conducted a very complicated procedure where the risk of his disability or even death was involved. The procedure gave him a new lease of life. The CT scan showed large intraparenchymal bleed. Patient was further referred to Interventional Radiology Department for DSA Cerebral Angiography.

 

It showed pial AV arteriovenous fistula with multiple venous aneurysms from frontal branch of Anterior cerebral artery. Pial arteriovenous fistulas (PAVFs) are rare vascular malformations where an artery directly connects to a vein without an intervening tangle of vessels, leading to a high-pressure gradient and potential for rupture, informed Dr Atul Rajkondawar, Head, Department of Medicine in GMCH. Such type of AV fistulas are rare to find with prevalence of 0.1-1 per 1 lakh. The biggest risk in such cases is re-rupture of AV fistula causing permanent disability and sometimes, death of the patient. After discussion with Medicine Department and proper counselling of parents, the decision was taken to embolise the AV fistula.

 

The patient was intubated and super-selectively cannulated the frontal branch of Anterior cerebral artery and injected concentrated glue thereby excluding the fistula with venous aneurysm from the circulation, thus saving the life of young boy. This entire procedure was result of team work from Medicine Department, Interventional Radiology Department, Radiology Department and Anesthesia Department from Trauma Centre. Patient was under the care of Medical unit 3 incharge Dr Vinod Khandait, Cardiologist and his team, which included Dr Yogesh Kachave, Dr Akshay Jaiswal, Dr Rishabh Jain, Dr Gunjan Mohokar and Dr Harshwardhan Meshram. The credit of complicated procedure goes to Dr Jawahar Rathod, Professor and Head, Interventional Radiology Department and his team of Dr Shivprasad Jaybhay, Assistant Professors Dr Aman Yusuf Khan; Dr Vishwas; Dr Arjun Anil in the presence of Interventional Cardiologist Dr Vinod Khandait. The Department of Radiology, Dr Aarti Aanand, Professor and Head and Anesthesia team led by Dr Vaijayanti played a significant role. Dean Dr Raj Gajbhiye and Medical Superintendent Dr Avinash Gawande congratulated the entire team.