Endovascular treatment of arteriovenous malformation in a child

Arteriovenous malformations are direct communications between the arterial and venous circulations without the usual passage through the capillary net. They are the most frequent type of malformations of the intracranial circulation and the second most frequent cause of intracranial hematomas or hemorrhage. We report on a 7-year-old girl with intracerebral hematoma following acute rupture of an arteriovenous malformation. The girl experienced a spontaneous headache and later became unconscious. At the time of admission to the hospital, her neurological status scored 5 on the Glasgow Coma Scale. Computerized tomography of the brain revealed a round hyperdense lesion in the left frontoparietal region. Digital subtractional angiography of the left internal carotid artery confirmed the suspicion of an arteriovenous malformation with one main feeding artery: a distal branch of the left anterior cerebral artery. The nidus was round and about 2 cm in diameter. The venous drainage was of the superficial type, flowing into the left superior sagittal sinus. After consultation with a neurosurgeon, we decided to treat the arteriovenous malformation by means of an endovascular technique. A flow-guided catheter was placed close to the nidus. Control angiography before embolization revealed the proper position for the injection of embolic material. We used the conventional mixture of acrylic polymerization glue, Lipiodol oil contrast medium and particles of tantalum powder. Control angiography at the end of the procedure revealed complete occlusion of the malformation. There were no signs of potential new feeding arteries that could appear as a result of changed hemodynamic conditions after embolization. Endovascular treatment of arteriovenous malformations could become the treatment of choice for these lesions, especially in combination with radiosurgery. The established microsurgical treatment is very effective but carries a higher risk of hemorrhagic complications.