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Paraspinal Arterio-Venous Fistula in Children: Two More Cases of an Exceptional Malformation
Nesrine Farhat1, Brigitte Desprechins2, Bernard Otto2
1Departments of 1Pediatrics.
Insights
Two toddlers diagnosed with rare paraspinal arteriovenous fistulae experienced heart murmurs. Interventional embolization is preferred, but monitoring asymptomatic cases is crucial to prevent spinal venous congestion.
Area of Science:
- Vascular Surgery
- Pediatric Cardiology
- Neurology
Background:
- Paraspinal arteriovenous fistulae (PAVF) are rare vascular malformations in children, presenting as congenital or post-traumatic lesions.
- These fistulae, especially those involving the spinal venous system, pose a risk of spinal vascular compromise due to venous congestion.
Observation:
- Two pediatric cases presented with cardiac and vascular murmurs, respectively, leading to the diagnosis of PAVF.
- The patients were toddlers, highlighting the potential for early presentation of this rare condition.
Findings:
- Interventional embolization is the primary treatment modality for PAVF, offering an alternative to surgical intervention.
- A consensus on prophylactic closure for asymptomatic PAVF is lacking, necessitating careful clinical evaluation.
Implications:
- Close clinical monitoring and serial spinal magnetic resonance imaging are essential for asymptomatic pediatric patients to detect and manage potential venous congestion.
- Early diagnosis and appropriate management of PAVF are critical to prevent long-term neurological complications in children.
Abstract:
We report on the case of two toddlers who presented in the last 2 years with heart and vascular murmur, respectively, and in whom the diagnosis of paraspinal arterio-venous fistula was made. Paraspinal arterio-venous fistulae in children are extremely rare congenital or post-traumatic vascular malformations. In the rare case of connection with the spinal venous system, they might affect spinal vascularization due to potential venous congestion. Interventional embolization rather than surgery is the treatment of choice for such lesions. Up to now, there is no consensus about the indication of prophylactic closure of asymptomatic fistulae. However, close clinical follow-up with repeated spinal magnetic resonance imaging to exclude venous congestion is mandatory for young asymptomatic patients until treatment.
