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Therapeutic progress in pediatric intracranial dural arteriovenous shunts: A review
Jinlu Yu1, Xianli Lv2, Youxiang Li2
1Department of Neurosurgery, First Hospital of Jilin University, Changchun, China jlyu@jlu.edu.cn.
Insights
Pediatric dural arteriovenous shunts (dAVS) are rare and often worsen if untreated. While challenging to manage, treatments like embolization offer improved outcomes for this pediatric vascular disease.
Area of Science:
- Neurology
- Vascular Surgery
- Pediatric Medicine
Background:
- Pediatric dural arteriovenous shunts (dAVS) are uncommon vascular malformations with limited research.
- Understanding their natural history and treatment is crucial due to potential deterioration.
Purpose of the Study:
- To review and summarize the existing literature on pediatric dAVS.
- To delineate classification, clinical manifestations, diagnostic methods, and treatment strategies.
Main Methods:
- Comprehensive literature search of PubMed for pediatric dAVS cases.
- Review and synthesis of reported data on classification, symptoms, imaging, and treatment outcomes.
Main Results:
- Pediatric dAVS have an unfavorable natural history, often progressing without treatment.
- Classified into Dural sinus malformation (DMS) with dAVS, infantile dAVS (IDAVS), and adult-type dAVS (ADAVS).
- Digital subtraction angiography (DSA) is the gold standard for diagnosis; transarterial embolization is the primary treatment, though surgical resection is also used.
Conclusions:
- Pediatric dAVS present with diverse symptoms and have a generally poor prognosis, even with treatment.
- Advancements in embolization techniques offer potential for improved therapeutic outcomes and patient prognoses.
Abstract:
Pediatric dural arteriovenous shunts (dAVSs) are a rare form of vascular disease: Fewer than 100 cases are reported in PubMed and the understanding of pediatric dAVS is limited. For this study, we searched in PubMed, reviewed and summarized the literature related to pediatric dAVSs. Our review revealed that pediatric dAVSs have an unfavorable natural history: If left untreated, the majority of pediatric dAVSs deteriorate. In a widely accepted classification scheme developed by Lasjaunias et al., pediatric dAVSs are divided into three types: Dural sinus malformation (DMS) with dAVS, infantile dAVS (IDAVS) and adult-type dAVS (ADAVS). In general, the clinical manifestations of dAVS can be summarized as having symptoms due to high-flow arteriovenous shunts, symptoms from retrograde venous drainage, symptoms from cavernous sinus involvement and hydrocephalus, among other signs and symptoms. The pediatric dAVSs may be identified with several imaging techniques; however, the gold standard is digital subtraction angiography (DSA), which indicates unique anatomical details and hemodynamic features. Effectively treating pediatric dAVS is difficult and the prognosis is often unsatisfactory. Transarterial embolization with liquid embolic agents and coils is the treatment of choice for the safe stabilization and/or improvement of the symptoms of pediatric dAVS. In some cases, transumbilical arterial and transvenous approaches have been effective, and surgical resection is also an effective alternative in some cases. Nevertheless, pediatric dAVS can have an unsatisfactory prognosis, even when timely and appropriate treatment is administered; however, with the development of embolization materials and techniques, the potential for improved treatments and prognoses is increasing.
