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Intracranial pial fistulas in pediatric population. Clinical features and treatment modalities
Flavio Requejo1, Roberto Jaimovich, Juan Marelli
1Department of Interventional Radiology, Hospital Nacional de Pediatria J P Garrahan, Combate de los Pozos 1881 (1254), Buenos Aires, Argentina, frequejo@intramed.net.
Insights
Intracranial pial arteriovenous fistulas (PAVFs) present with diverse symptoms in children. Endovascular treatment is effective for PAVFs, achieving total occlusion in all cases studied.
Area of Science:
- Pediatric Neurology
- Vascular Neurosurgery
- Interventional Radiology
Background:
- Intracranial pial arteriovenous fistulas (PAVFs) are rare vascular malformations.
- Understanding their clinical spectrum and treatment outcomes is crucial for pediatric neurovascular care.
Purpose of the Study:
- To delineate the clinical manifestations of PAVFs in pediatric patients.
- To describe the treatment modalities and outcomes for PAVFs.
Main Methods:
- Retrospective analysis of 10 pediatric PAVF cases from 2004-2013.
- Review of medical records, imaging, and procedural reports.
- Data collection on demographics, presentation, treatment, and outcomes.
Main Results:
- Median age of patients was 7.5 years; 60% were male.
- PAVFs were supratentorial (60%) or in the posterior fossa (40%).
- Presentations included intracranial bleeding, seizures, headaches, growth retardation, hydrocephalus, and CHF/VGAM; endovascular therapy (80%) or surgery (20%) achieved total occlusion.
Conclusions:
- PAVFs manifest diversely in the pediatric population.
- Endovascular treatment is a safe and effective option for PAVFs, particularly when the venous side can be occluded.
Purpose:
The purpose of the study is to describe the clinical manifestations and treatment modalities of patients having intracranial pial arteriovenous fistulas (PAVFs).
Methods:
We retrospectively analyzed the cases of PAVFs from January 2004 to December 2013. Medical charts, diagnostic images, surgical, and endovascular reports were reviewed retrospectively during each of the procedures and follow-up. We recorded patient demographics, clinical presentation, treatment modalities, and outcome.
Results:
Ten patients with single PAVFs were identified, one of them with multiple holes. The median age was 7.5 years old (20 days to 14 years). Six patients were male (60% of cases). Four PAVFs were localized in the posterior fossa, and six were supratentorial (60%). Two patients had intracranial bleeding, three presented seizures, one was studied for chronic headaches, three manifested by growth retardation, one had hydrocephalus, and one had a congestive heart failure (CHF) and vein of Galen aneurysmal malformation (VGAM). The latter did not improve after embolization and died few days later. Endovascular therapy was used in eight, whereas two patients were surgically managed. Total occlusion of the fistula was achieved in all cases.
Conclusions:
PAVF affects pediatric population at different ages with miscellaneous clinical manifestations. Endovascular treatment is safe and effective when the venous side of the fistula can be occluded.
