Characteristics and outcomes of pediatric dural arteriovenous fistulas: a systematic review

Abstract

BackgroundDural arteriovenous stulas (dAVF) are arteriovenous shunts in communication with the dural vasculature in the brain or spine. Apart from single-center series, risk factors and treatment outcomes for pediatric dAVFs are largely undescribed. MethodsWe performed a systematic literature review of pediatric (< 18 years at diagnosis) intracranial and spinal dAVF according to PRISMA guidelines. We queried PubMed, CINAHL, SCOPUS, and Embase databases without time/date restriction. Search strings included a variety of MeSH keywords relating to dural AV stulas in combination with MeSH keywords related to pediatric cases (see Appendix). Manuscripts describing patients diagnosed with dural sinus malformations or pial AVF were excluded. ResultsWe identi ed 61 studies describing 69 individual patients. Overall, dAVF were more common in males (55.1%) with a mean age of diagnosis (5.17 ± 4.42 years). Approximately 20.2% of patients presented with cardiovascular disease (CVD), and 31.9% were discovered incidentally on neuroimaging studies.Transverse-sigmoid junction was the most common location (17.3%). Ninety-three percent (64 patients) were treated, most commonly using endovascular embolization (68.1%) followed by surgery (8.7%) and radiosurgery (2.9%). Almost half (43.8%) of dAVFs were completely obliterated. Of the 64 procedures, there were 19 neurological complications (29.7%) of varying severity where 12.5% were considered transient (i.e., pseudomeningocele) and 17.2% permanent (i.e., mortality secondary to acute sinus thrombosis, etc.). ConclusionThere is a paucity of information on pediatric dAVFs. This systematic review summarizes the published cases of dAVFs in the pediatric population. While the rate of missing data is high, there is publication bias, and precise details regarding complications are di cult to ascertain, this review serves as a descriptive summary of pediatric dAVFs.

Congenital Intracranial Vascular Malformations in Children : Radiological Overview

“…AVFs comprise approximately 4% of pediatric cerebral vascular malformations [ 15 ]. These lesions can be categorized into three entities : VGAM, pial AVF, and dural AVF within the context of dural sinus malformations (DSMs) [ 7 , 8 , 12 ].…”

“…Cerebral venous hypertension and intracranial hemorrhage can also be seen in case the intracranial venous drainage is compromised by the thrombosed sinus/vein. MRI and MR angiography are usually obtained to better evaluate the brain parenchyma and for better evaluation of the angioarchitecture of the dural AVF [ 6 , 12 , 16 ] ( Fig. 6 ).…”