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Pediatric traumatic dural arteriovenous fistula
Michael Vassilyadi1, Naveen Mehrotra, Mohammed F Shamji
1Division of Neurosurgery, Children's Hospital of Eastern Ontario, Ottawa, Ontario, Canada.
Insights
Traumatic pediatric dural arteriovenous fistulas are rare. Surgical intervention may be necessary after failed endovascular treatment, offering a good long-term outcome for children.
Area of Science:
- Pediatric neurosurgery
- Vascular neurology
- Traumatic brain injury management
Background:
- Dural arteriovenous fistulas (dAVFs) are rare in children, often resulting from trauma.
- Management requires careful assessment of presentation, neurological status, and anatomy.
- Surgery may be needed if endovascular treatment fails.
Observation:
- A 12-year-old boy developed a dural arteriovenous fistula after a bicycle accident.
- The fistula involved the middle meningeal artery and a dural vein draining into the sigmoid sinus.
- Initial symptoms included a temporal bruit.
Findings:
- Endovascular treatment with embolization and coiling was unsuccessful.
- Surgical excision of the fistula via craniectomy was performed.
- The patient recovered well with no neurological deficits or recurrence after six years.
Implications:
- Traumatic dural arteriovenous fistulas can occur in children, potentially from minor arterial injury.
- Failure of endovascular techniques may necessitate surgical management.
- Surgical treatment can lead to favorable long-term outcomes in pediatric dAVFs.
Background:
Dural arteriovenous fistulas are uncommon lesions in children, with traumatic lesions suspected to arise from incomplete arterial injury in proximity to a vein or draining sinus. Management of symptomatic acquired lesions requires evaluation of patient presentation, neurological status, and pathoanatomic configuration, with special consideration required for surgery secondary to failed endovascular technique.
Case Report:
A 12-year-old male sustained a bicycle fall causing a right temporo-parietal skull fracture associated with non-surgical right epidural hematoma and left contre-coup parietal contusion. Six-weeks later, he complained of a right temporal bruit with subsequent cerebral angiography demonstrating a dural-based fistula between the right middle meningeal artery and a dural vein draining into the sigmoid sinus.
Intervention:
Endovascular treatment of this lesion with glue embolization and coiling was unsuccessful, with angiographic illustration of previously unobserved collateral vessels and coils occupying the sigmoid sinus. A right temporo-parietal craniectomy was required to excise the dural-based fistula, followed by dural defect repair with bovine pericardium and subsequent cranioplasty. Six years later the patient remains neurologically intact with no headaches or bruit.
Conclusions:
Dural arteriovenous fistula can uncommonly occur following traumatic injury in children. Partial injury to the middle mengineal artery may have established arterial communication with the draining vein that became ectatic and tortuous under high pressure. Failure of primary endovascular treatment may complicate secondary surgical intervention.
