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Neonatal superficial cerebral arteriovenous malformations
H Hara1, P E Burrows, O Flodmark
1Department of Diagnostic Imaging, Hospital for Sick Children, Toronto, Ont., Canada.
Pediatric Neurosurgery
|January 1, 1994
Summary
Early intervention and complete angiographic study are crucial for neonates with high-flow pial arteriovenous malformations (AVM). Prompt treatment improves outcomes, while incomplete diagnosis can lead to poor prognosis.
Area of Science:
- Neonatal Neurology
- Pediatric Neurosurgery
- Vascular Malformations
Background:
- High-flow pial arteriovenous malformations (AVM) in neonates can lead to severe complications like cardiac failure and cerebral ischemia.
- Early diagnosis and intervention are critical for improving outcomes in affected infants.
Observation:
- This report details 4 neonates with pial AVM, reviewing their imaging and treatment outcomes.
- Three infants underwent surgical resection, with 2 achieving complete resection and 1 partial. One infant experienced postoperative hemorrhagic infarction.
- The fourth infant, with absent deep venous drainage, died from intracranial hemorrhage after transvenous embolization.
Findings:
- Complete angiographic study is essential for accurately assessing complex vascular anatomy and planning effective treatment.
- Cranial ultrasound aids early diagnosis but may miss superficial lesions.
- Early surgical intervention in selected cases, following comprehensive imaging, demonstrated beneficial outcomes with no worsening of neurologic deficits in 2 patients.
Implications:
- Comprehensive angiographic investigation is vital for surgical planning and risk stratification in neonatal pial AVM.
- Timely and complete treatment, guided by accurate imaging, can prevent poor prognosis associated with untreated AVMs.
- This study underscores the importance of early, aggressive management strategies for high-flow pial AVMs in neonates.