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Comprehensive Endovascular and Open Surgical Management of Cerebral Arteriovenous Malformations
Published on: October 20, 2017
Management of spinal dural arteriovenous fistula in a child with myelopathy
Jeremy Rajadurai1, Saeed Kohan1, Jason Wenderoth2
1Departments of Neurosurgery, Sydney Childrens Hospital, Randwick, New South Wales, Australia.
Insights
Spinal dural arteriovenous fistulas (DAVF) are rare in children but treatable. Prompt diagnosis and intervention lead to significant recovery, preventing serious neurological damage.
Area of Science:
- Pediatric Neurology
- Vascular Neurosurgery
- Neuroradiology
Background:
- Spinal dural arteriovenous fistulas (DAVF) are rare intradural spinal lesions.
- Typically affect adults aged 40-50 with acute neurological deterioration.
- Exceedingly rare in the pediatric population.
Observation:
- A 2-year-old child presented with acute lethargy and left lower extremity weakness with ataxia.
- Cervicothoracic MRI revealed central cord edema (C5-T4).
- Diagnosis of DAVF confirmed by dilated intradural perimedullary veins.
Findings:
- Endovascular treatment resulted in marked recovery.
- The child remained neurologically stable 2 years post-intervention.
- DAVFs, though rare in children, are associated with significant neurological morbidity.
Implications:
- Early diagnosis of pediatric DAVF is crucial.
- Requires prompt magnetic resonance imaging/angiography and formal angiography.
- Immediate neurosurgical and endovascular consultation is vital for optimal treatment strategy and outcomes.
Background:
Spinal dural arteriovenous fistulas (DAVF) are rare intradural spinal lesions. Patients with DAVF are typically in the 40's or 50's, and classically present with acute neurological deterioration. Notably, these lesions are exceedingly rare in the pediatric age group.
Case Description:
A 2-year-old child presented with the sudden onset of lethargy, and 4/5 weakness of the left lower extremity with accompanying ataxia. The cervicothoracic MR scan revealed central cord edema from C5 to T4. A DAVF was diagnosed based on the multiple dilated intradural perimedullary veins. Following endovascular treatment, the child markedly recovered and remained stable 2 years later.
Conclusion:
DAVFs are treatable lesions that rarely occur in the pediatric age group. They are associated with serious neurological morbidity. When suspected, they should be immediately diagnosed with magnetic resonance imaging/magnetic resonance angiography, and formal angiography. Prompt neurosurgical and neuroradiological/ endovascular opinions and intervention should be sought to provide and the best treatment strategy.
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