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Comprehensive Endovascular and Open Surgical Management of Cerebral Arteriovenous Malformations
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Pediatric dural arteriovenous malformations

Shaun P Appaduray1, James A J King, Alison Wray

  • 1Department of Neurosurgery, The Royal Children's Hospital Melbourne, Parkville, Victoria, Australia.

Journal of Neurosurgery. Pediatrics
|May 29, 2014
PubMed

Insights

Pediatric dural arteriovenous malformations (dAVMs) are rare and dangerous. Prompt endovascular embolization offers the best chance for favorable outcomes in children with dAVMs, despite potential complications.

Area of Science:

  • Neurology
  • Pediatric Neurosurgery
  • Vascular Malformations

Background:

  • Pediatric dural arteriovenous malformations (dAVMs) are rare, complex vascular lesions with high mortality.
  • Management of pediatric dAVMs requires specialized neurosurgical and endovascular expertise.

Observation:

  • Three pediatric dAVM cases presented with macrocrania and extracranial venous distension.
  • Two cases developed dural sinus thrombosis pre-intervention, an unusual presentation.
  • Complications included dural sinus thrombosis, hemorrhage, venous hypertension, and seizures.

Findings:

  • Staged endovascular embolization was the treatment strategy for all three cases.
  • One patient had a favorable outcome, while two experienced poor outcomes.
  • Prompt endovascular embolization is associated with the best available results for pediatric dAVMs.

Implications:

  • Endovascular embolization is crucial for managing pediatric dAVMs.
  • Venous collateral circulation to internal jugular veins may improve treatment outcomes.
  • Further research is needed to optimize management strategies and improve outcomes for pediatric dAVMs.

Keywords:
DSA = digital subtraction angiographyECA = external carotid arteryICA = internal carotid arteryIJV = internal jugular veinIOP = intraocular pressureMMA = middle meningeal arteryOA = occipital arterydAVM = dural arteriovenous malformationdAVS = dural arteriovenous shuntdural arteriovenous malformationendovascular embolizationsinus thrombosisvascular disorders

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