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Intracranial arteriovenous anomalies of infancy: modern concepts
1Department of Surgery, University of Iowa Hospital, Iowa City.
Insights
Pediatric cerebrovascular abnormalities like vein of Galen aneurysms can cause heart failure and head enlargement. Early diagnosis and intervention, including surgery or embolization, led to positive outcomes in young children.
Area of Science:
- Pediatric Neurology
- Vascular Malformations
- Pediatric Cardiology
Background:
- Cerebrovascular abnormalities are a concern in early childhood.
- Congenital anomalies can present with serious symptoms like heart failure and hydrocephalus.
Observation:
- Seven infants (1 week to 7 months) presented with congestive heart failure and/or head enlargement.
- Diagnosed anomalies included vein of Galen aneurysms, arteriovenous fistulas, and dural arteriovenous malformations.
Findings:
- Computed tomography and digital subtraction angiography were key diagnostic tools.
- Surgical intervention or embolization was performed in all cases.
- Congestive heart failure resolved in 2/3 surgical cases and improved with embolization.
- Hydrocephalus improved in 2 cases post-fistula elimination.
Implications:
- Timely diagnosis and treatment of pediatric cerebrovascular malformations are crucial.
- Interventional techniques can effectively manage these complex conditions.
- Favorable neurological outcomes are achievable with prompt management.
Abstract:
A variety of cerebrovascular abnormalities may become manifest in the first years of life. We present our recent experience with 7 children, ages 1 week to 7 months of age, who presented with congestive heart failure and progressive head enlargement (3), heart failure alone (1) and head enlargement alone (2). The anomalies include vein of Galen aneurysm (3), complex arteriovenous fistula (2) and posterior fossa dural arteriovenous malformations (2). Computed tomographic scanning was invaluable in delineating the site of the lesion while arterial digital subtraction angiography was utilized to obtain the high-quality images, reduced dye volume and rapid filming. Direct surgical intervention was accomplished in 5 cases, while embolization was utilized in 2. One child underwent direct partial occlusion and embolization. Congestive heart failure resolved in 2 of 3 operated cases and improved in those undergoing embolization. Hydrocephalus improved in 2 cases with the elimination of the fistula. Morbidity included seizures and a hemorrhagic infarction in 1 case. Neurologic outcome was satisfactory and there was no surgical mortality.