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Published on: October 20, 2017
Neuro-Interventions for the Neonates with Brain Arteriovenous Fistulas: With Special Reference to Access Routes
Masaki Komiyama1, Aiko Terada, Tomoya Ishiguro
1Department of Neuro-Intervention, Osaka City General Hospital.
Insights
Neonatal neuro-intervention for brain arteriovenous fistulas (AVFs) is complex. Femoral arterial access is suitable for neonates >2,700g, but alternative routes are crucial for those <2,200g.
Area of Science:
- Neurology
- Pediatric Interventional Radiology
- Vascular Surgery
Background:
- Neonatal neuro-intervention presents unique challenges, particularly for brain arteriovenous fistulas (AVFs).
- AVFs in neonates often manifest as severe cardiac failure, necessitating timely intervention.
- Access route selection is critical for successful neuro-intervention in this vulnerable population.
Purpose of the Study:
- To report on neuro-intervention outcomes for neonates with brain AVFs.
- To specifically analyze the effectiveness and challenges of various access routes in neonatal neuro-intervention.
- To identify optimal access strategies based on neonatal birth weight.
Main Methods:
- Retrospective review of neuro-interventions in 15 neonates (within 14 days of life) with brain AVFs.
- Analysis of diagnoses including vein of Galen aneurysmal malformation, dural sinus malformations, pial AVF, and epidural AVF.
- Detailed examination of access routes used (femoral arterial/venous, umbilical arterial/venous, transcardiac, direct carotid) and their success rates relative to birth weight.
Main Results:
- All 15 neonates presented with severe cardiac failure.
- A total of 29 interventions were performed.
- Neonates >2,700g (n=12) were successfully treated via transfemoral arterial routes; those <2,200g (n=3) required alternative access routes.
- Interventions utilized femoral arterial (19), femoral venous (3), umbilical arterial (2), umbilical venous (3), transcardiac (3), and direct carotid (2) routes.
Conclusions:
- Transfemoral arterial access with a 4F sheath is feasible for neonatal neuro-intervention in infants >2,700g.
- Alternative vascular access routes are essential for successful neuro-intervention in neonates weighing <2,200g.
- Optimizing access strategies is key to improving outcomes in neonatal brain AVF treatment.
Abstract:
Neonatal neuro-intervention is challenging. The purpose of this article is to report the neuro-intervention for the neonates with brain arteriovenous fistulas (AVFs), with special reference to access routes. Fifteen neonates (12 boys and 3 girls) who underwent neuro-intervention within the first 14 days of life were -included. Their diagnoses included vein of Galen aneurysmal malformation (6), dural sinus malformations with arteriovenous (AV) shunts (6), pial AVF (2), and epidural AVF (1). Birth weight ranged from 1,538 g to 3,778 g (mean 2,525 g). Neuro-interventions, especially access routes, in the neonatal periods (< 1 month) were retrospectively reviewed. All neonates presented with severe cardiac failure. In total, 29 interventions (mean 1.9) were performed within 1 month. Although 12 neonates with birth weight more than 2,700 g could be treated through transfemoral arterial routes, 3 neonates with birth weight less than 2,200 g could not be treated successfully by femoral arterial routes. Interventions were performed through 19 femoral arterial, 3 femoral venous, 2 umbilical arterial, 3 umbilical venous, 3 transcardiac, and 2 direct carotid routes. Their overall outcomes were six good recovery, one moderate disability, two severe disabilities, one vegetative state, and five deaths with a mean follow-up period of 7 years 2 months. Neuro-intervention for the neonates with birth weight more than 2,700 g can be performed by femoral arterial routes using a 4F sheath. For those with birth weight less than 2,200 g, however, alternative access routes are required.
