1 Neuroradiologie Interventionnelle, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland;
2 Referral Centre for Neurovascular Disease in Children, Service de Neuroradiologie, Hôpital Bicêtre;
3 Service de Neuroradiologie, Hôpital Bicêtre;
4 Anesthésie Pédiatrique, Hôpital Bicêtre; Laboratoire d’Anesthésie UMR788 “Neuroprotection, Régénération des Axones et de la Myéline,” Université Paris-Sud, Faculté de Médecine du Kremlin-Bicêtre; and
5 Réanimation Pédiatrique, Hôpital Bicêtre, Le Kremlin Bicêtre, France
Endovascular treatment in children, especially neonates, can be more challenging than analogous procedures in adults. This study aimed to describe the clinical and radiological findings, type and timing of endovascular treatment, and early outcomes in children who present with neurovascular malformations, who are treated with embolization, and who weigh less than 5 kg.
The authors carried out a retrospective review of all consecutively treated children weighing less than 5 kg with neurovascular arteriovenous malformations (AVMs) at a single institution over a 10-year period.
Fifty-two patients were included in the study. Thirty-eight had a vein of Galen aneurysmal malformation, 3 a pial AVM, 6 a pial arteriovenous fistula, and 5 a dural sinus malformation. The endovascular treatment goals were control of cardiac failure or hydrocephalus in cases of nonhemorrhagic malformations or to prevent new bleeding in cases of previous hemorrhage. A hemorrhagic complication occurred in 12 procedures and an ischemic complication in 2. Both complication types were correlated with the age of the infant (age cutoff at 3 months) (p = of 0.015 and 0.049, respectively). No correlation was found with the weight of the infant or the duration of the procedure.
The embolization of AVMs in these patients prevented adverse cardiac effects, hydrovenous disorders, and rebleeding. The risk of major cerebral complications seems mainly correlated with age, with a threshold at 3 months. A multidisciplinary team involved in the treatment of these children may help to improve treatment success and management.
MadsenPJLangSSPisapiaJMStormPBHurstRWHeuerGG: An institutional series and literature review of pial arteriovenous fistulas in the pediatric population: clinical article. J Neurosurg Pediatr12:344–3502013
MeilaDHannakRFeldkampASchlunz-HendannMMangoldAJacobsC: Vein of Galen aneurysmal malformation: combined transvenous and transarterial method using a “kissing microcatheter technique”. Neuroradiology54:51–592012
PuccinelliFDeivaKBellesmeCDurandPChevretLHussonB: Cerebral venous thrombosis after embolization of pediatric AVM with jugular bulb stenosis or occlusion: management and prevention. Eur J Paediatr Neurol18:766–7732014