Osseous craniofacial arteriovenous malformations in the pediatric population

Osseous craniofacial arteriovenous malformations are rare and challenging entities. A 20-year retrospective review at our institutions identified 47 cases of craniofacial arteriovenous malformations, 3 of which were in children with extensive osseous facial structure involvement. Diagnostic evaluation included computed tomography, magnetic resonance imaging, and angiography. A 3-stage treatment protocol employed both transarterial embolization and direct intralesional puncture embolization followed by complete surgical resection. Mean intraperative blood loss was limited to 1000 mL. There were no complications during therapy. All 3 patients are without recurrence at 2- to 4-year follow-up. Osseous craniofacial arteriovenous malformations should be approached with multimodality therapy, incorporating interventional neuroradiologic and surgical management. Using the outlined protocol, these lesions can be treated safely and effectively.