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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.
Insights
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.
Abstract:
The purpose of this report is to determine the role of various imaging modalities, and the outcome of early intervention in neonates with high flow pial arteriovenous malformations (AVM). This report describes 4 neonates with pial AVM associated with congestive cardiac failure, and reviews previous reports. Among the 4 infants in our series, 3 underwent early surgical resection of the AVM, complete in 2 and partial in 1. One infant suffered hemorrhagic infarction postoperatively and has a mild deficit on clinical follow-up; the other 2 patients had no worsening of mild neurologic deficits after surgery, and subsequent development has been normal. The fourth infant had absent deep venous drainage and died from intracranial hemorrhage following transvenous embolization. A single vessel arteriogram in 1 infant led to underestimation of the lesion and unexpected findings at surgery. Complete angiographic study is important in planning treatment, as the vascular anatomy of the lesions may be complex. Cranial ultrasound is useful in early diagnosis, but may miss the superficial lesions. Untreated infants with pial AVM have a poor prognosis due to cardiac failure or progressive cerebral ischemia and neurologic regression. This series illustrates the benefits of complete angiographic investigation and early treatment.