Embolization of cerebral arteriovenous shunts in infants weighing less than 5 kg

Area of Science:

• Pediatric Neurosurgery
• Interventional Neuroradiology
• Vascular Malformations

Background:

• Endovascular treatment of neurovascular malformations in neonates and infants presents unique challenges compared to adults.
• Infants weighing less than 5 kg with these conditions require specialized management strategies.

Purpose of the Study:

• To describe clinical and radiological findings in infants under 5 kg with neurovascular malformations.
• To detail the endovascular treatment type, timing, and early outcomes in this specific pediatric population.
• To analyze factors influencing complications in the endovascular treatment of pediatric neurovascular malformations.

Main Methods:

• Retrospective review of consecutively treated children weighing less than 5 kg with neurovascular arteriovenous malformations (AVMs).
• Data collected over a 10-year period at a single institution.
• Analysis of patient demographics, malformation types, treatment goals, and procedural outcomes.

Main Results:

• Fifty-two patients were included, with vein of Galen aneurysmal malformation being the most common (38 patients).
• Endovascular treatment aimed to control cardiac failure, hydrocephalus, or prevent bleeding.
• Hemorrhagic complications occurred in 12 procedures and ischemic complications in 2, both correlated with infant age (cutoff at 3 months).

Conclusions:

• Embolization of AVMs in infants under 5 kg effectively prevents adverse cardiac effects, hydrovenous disorders, and rebleeding.
• The risk of major cerebral complications is primarily associated with infant age, with a significant threshold around 3 months.
• A multidisciplinary team approach is recommended to optimize treatment success and management for these complex pediatric cases.