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Huge cerebral pial arteriovenous fistula in a newborn: illustrative case
Vadim Berestov1,2, Pavel Seleznev2, Natalya Obedinskaya3
11Department of Endovascular Neurosurgery, Federal Center of Brain Research and Neurotechnologies, Federal Biomedical Agency of Russian Federation, Moscow, Russian Federation.
Insights
Endovascular embolization using coils successfully treated a rare, high-flow arteriovenous fistula in a newborn, preventing serious complications and ensuring normal development.
Area of Science:
- Pediatric Neurology
- Vascular Surgery
- Interventional Radiology
Background:
- Pediatric arteriovenous malformations (AVMs) and pial/dural arteriovenous fistulas (AVFs) are rare but severe conditions in newborns.
- These vascular anomalies can cause critical issues like congestive heart failure and hemorrhagic stroke.
- Aggressive surgical intervention is often required due to significant shunting and early complications.
Purpose of the Study:
- To describe the endovascular treatment of an atypical cerebral pial AVF in a newborn.
- To evaluate the efficacy and safety of embolization for this condition.
Main Methods:
- An atypical cerebral pial AVF was identified, directly connecting the basilar artery to a dilated deep cerebral vein.
- Subtotal embolization was performed using 0.020-inch coils.
- The patient underwent clinical and radiological follow-up.
Main Results:
- The embolization led to progressive thrombosis of the AVF.
- Normal arterial blood flow was restored.
- The infant showed no physical or mental developmental delay at 1.5 and 6 months post-procedure.
Conclusions:
- Subtotal coiling is an effective treatment for high-flow pial AVFs in newborns.
- This endovascular approach can lead to favorable clinical outcomes and normal development.
Background:
Pediatric arteriovenous malformations (AVMs) and pial/dural arteriovenous fistulas (AVFs) are rare but life-threatening complications that can lead to congestive heart failure and hemorrhagic stroke in newborns and pediatric patients. The pronounced shunting in these conditions is associated with early complications and necessitates aggressive surgical management. Here, the authors describe endovascular treatment of an atypical cerebral pial AVF in a newborn.
Observations:
This AVF formed direct communication between a major cerebral artery (basilar artery) and a large draining vein (dilated deep cerebral vein). The authors performed earlier subtotal embolization of the AVF using 0.020-inch coils, which led to progressive thrombosis of the fistula with restoration of normal arterial blood flow. The patient was discharged 18 days after surgery, examination at 1.5 and 6 months showed magnetic resonance imaging signs of blood flow absence through the fistula and satisfactory condition of the infant without physical and mental developmental delay.
Lessons:
Subtotal coiling of a high-flow pial AVF in a newborn can result in a good clinical outcome.
