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Spinal type IV arteriovenous malformations (perimedullary fistulas) in children
U Sure1, J P Wakat, S Gatscher
1Department of Neurosurgery, Philipps University, Marburg, Germany. sure@post.med.uni-marburg.de
Insights
Intradural perimedullary spinal arteriovenous fistulas (AVFs), a type of spinal arteriovenous malformation (AVM), require prompt diagnosis in children with spinal symptoms. Combined treatment is effective and safe for these rare pediatric vascular malformations.
Area of Science:
- Neurology
- Neurosurgery
- Pediatric Neurology
Background:
- Intradural perimedullary spinal arteriovenous fistula (AVF) is a type IV spinal arteriovenous malformation (AVM).
- These malformations present a diagnostic challenge in pediatric patients with spinal symptoms.
Observation:
- Four pediatric patients with spinal AVMF IV were treated.
- Three patients underwent surgery after endovascular treatment for persistent fistulas.
Findings:
- Complete obliteration of malformations was achieved in all patients.
- No treatment-related morbidity was observed.
- Neurological symptoms resolved in three patients post-treatment.
Implications:
- Spinal arteriovenous malformations should be considered in pediatric patients with progressive or acute spinal symptoms.
- Combined endovascular and surgical treatment for pediatric spinal AVM type IV (perimedullary AVFs) is effective with low morbidity.
Objects:
Intradural perimedullary spinal arteriovenous fistula (AVF) is a synonym for type IV spinal arteriovenous malformation (AVM). It is an important clinical differential diagnosis in all patients with slowly progressive or acute spinal symptoms. Perimedullary AVFs are rare in the paediatric age group. We report the treatment regimen and the clinico-radiological findings for these malformations at our institution.
Methods:
Of four paediatric patients, three individuals with persistent fistulas after endovascular treatment were operated on. The malformations were obliterated completely in all patients without any morbidity. In three patients previously documented neurological symptoms resolved during follow-up.
Conclusions:
If slowly progressive or acute radicular or medullary symptoms arise in children, a spinal arteriovenous malformation should be ruled out by MRI. A combined endovascular and surgical treatment of paediatric spinal AVM type IV (perimedullary AVFs) carries a low risk of morbidity and is reasonably effective.