Perimedullary arteriovenous fistulas in pediatric patients: clinical, angiographical, and therapeutic experiences in a series of 19 cases

Abstract

PMAVFs in pediatric population exhibit many characteristics in clinical and angiographical aspects, need for special considerations. Most of PMAVFs in pediatric patients are high-flow fistulas, and endovascular embolization should be the first choice of treatment. After appropriate therapy, most of children can get satisfactory outcomes.

Endovascular embolization for symptomatic perimedullary AVF and intramedullary AVM: a series and a literature review

“…Some authors reported that spinal cord deficits associated with a consistent portion of the menstrual cycle may suggest the possibility of an arteriovenous malformation of the spinal cord [43]. Of intradural AVMs, 3.2-5.1% were associated with various syndromic associations, including Cobb, Klippel-Trenaunay-Weber, Parkes Weber, or Rendu-Osler-Weber diseases [15,23,42]. Spontaneous thrombosis of the perimedullary AVF and intramedullary AVM, although often referred to by those who oppose interventional treatment [44], is, in fact, rare (0.7%).…”

“…(Table 2) and can be treated via both endovascular and direct surgical approaches. Coils, glues, and balloons have all been used to embolize these fistulae [14,15,20]. Most of perimedullary AVFs in pediatric patients are high-flow fistulas, and endovascular embolization should be the first choice of treatment.…”

“…We excluded spinal dural AVFs. In the previously published literature, we found 20 literatures of perimedullary AVF (Table 3) [14][15][16][17][18][19][20] and 28 literatures of intramedullary AVM (Table 4) [21][22][23][24][25][26][27][28][29][30][31][32][33], all of which were well described with clinical and angiographic information. These previously reported cases were analyzed together, with special attention to their clinical characteristics.…”

Study and therapeutic progress on spinal cord perimedullary arteriovenous fistulas

“…Meng et al studied 19 child PMAVF cases in 2010, and in this limited study, the treatment outcomes were satisfactory. Of the 14 children who were followed-up, 42.9% (6/14) were succefully treated and 7 (50%) had greatly improved (79). Cervical PMAVFs can also achieve good therapeutic outcomes, as identified by Endo et al In that study, 20 of 22 patients were rated as having a good recovery 6 months after surgery (20).…”

27 Spinal Arteriovenous Fistulas

“…[39], [41] PMAVF is usually diagnosed between the third and sixth decades of life and are very rare, particularly in children. [42]The exact prevalence of PMAVFs is unknown but it is estimated that they constitute 4%-40% of spinal AVMs. [43], [44] Although the thoracolumbar spinal cord is the most common site of PMAVFs, these lesions can be seen at cervical and thoracic levels as well.…”