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Multifocal dural arteriovenous shunts in children
R Garcia-Monaco1, G Rodesch, K Terbrugge
1Unité de Neuroradiologie Vasculaire Diagnostique et Thérapeutique, Hôpital Bicêtre-Université Paris Sud, Le Kremlin Bicêtre, France.
Summary
Multiple dural arteriovenous (AV) shunts in children are rare and severe, presenting with varied symptoms. Current treatments offer symptomatic relief but not a cure, with recurrence being common.
Area of Science:
- Pediatric Neurology
- Vascular Malformations
- Neuroradiology
Background:
- Multiple dural arteriovenous (AV) shunts are a rare and severe condition in children.
- The etiology and evolutionary nature of these shunts are not fully understood.
Purpose of the Study:
- To describe the clinical presentation, treatment challenges, and outcomes of multiple dural AV shunts in pediatric patients.
- To evaluate the effectiveness of current therapeutic strategies for this condition.
Main Methods:
- Retrospective analysis of four consecutive pediatric cases with multiple dural AV shunts.
- Review of clinical data, radiological findings, and treatment interventions.
Main Results:
- Patients presented with cardiac, cerebrospinal fluid, and neurological symptoms, including intracranial hemorrhage and cranial bruits.
- No radical cure was achieved with current endovascular or surgical techniques.
- Symptomatic treatment, primarily arterial embolization, provided temporary relief but recurrence was frequent.
- Secondary pial AV shunts developed in two cases, possibly induced by venous drainage alterations.
Conclusions:
- Multiple dural AV shunts in children pose significant management challenges due to the lack of curative treatments and high recurrence rates.
- Arterial embolization is a rational approach for symptomatic management.
- The condition may represent a manifestation of a more complex underlying disease process.