Supratentorial cerebral arteriovenous fistulas (AVFs) in children: review of 41 cases with 63 non choroidal single-hole AVFs

Weon, Young Cheol; Yoshida, Yuichi; Sachet, M.; Mahadevan, Jeyaledchumy; Álvarez, H.; Rodesch, Georges; Lasjaunias, P.

doi:10.1007/s00701-004-0341-1

Cited by 123 publications

(160 citation statements)

References 5 publications

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“…6,11,18,22,33 However, despite this increasing therapeutic potential, reluctance to use CA in small children remains. This hesitation stems from a presumed increase in technical difficulty and anatomic limitations in gaining access and performing intracranial catheter manipulation.…”

Section: Discussionmentioning

confidence: 99%

“…These increases are the result of continued technical advances, the advent of intraarterial chemotherapy for retinoblastoma, and increasing awareness of the significance of cerebrovascular disorders and stroke in the pediatric population. 1,2,6,18,22,27,33 Despite this increase in therapeutic potential, hesitation to perform CA in young children remains. This hesitation stems from a persistent assumption that the rate of complications resulting from femoral access and intracranial catheter navigation are higher for this population because of the smaller vessel-to-catheter ratio and resultant higher risk for vasospasm, dissection, and peripheral vascular injury.…”

Section: ©Aans 2014mentioning

confidence: 99%

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Complications of cerebral angiography in children younger than 3 years of age

Hoffman¹,

Santillán²,

Rotman³

et al. 2014

PED

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Object The therapeutic potential for cerebral angiography (CA) in young children is expanding. However, its use in this patient population is limited by presumed higher complication rates among children. Therefore, to improve the accuracy of counseling of the parents/guardians of these patients and to identify modifiable risk factors, the authors evaluated complications after CA in young children. Methods The authors reviewed data for 309 consecutive cerebral angiograms obtained in 87 children younger than 36 months of age from 2004 to 2010 at a single institution. They analyzed demographics, diagnosis, angiographic findings, and complications. Results The patient population comprised 40 boys and 47 girls; mean age was 14.36 months (range 1–36 months) and mean weight was 10.8 kg (range 3.7–21.0 kg). For 292 of the 309 procedures, intraarterial chemotherapy was administered; the remaining 17 procedures were for vascular malformations, stroke, tumor embolization, and intracranial hemorrhage. The rate of neurological complications was 0.0%. The rate of nonneurological complications was 2.9%: 7 cases of contrast allergy or bronchospasm, 1 groin hematoma (body weight 7 kg), and 1 transient femoral artery occlusion (body weight 10.8 kg). The rate of radiographic complications was 1.3%: 1 case of transient asymptomatic intraarterial dissection and 3 cases of asymptomatic vasospasm. Postprocedural MRI was performed for 33.3% of patients with no evidence of ischemia. There were no delayed complications. Mean follow-up time was 16.6 months. No association was found between complications and age, duration of anesthesia, number of vessels catheterized, size of the sheath, or diagnostic versus interventional procedures. Despite a trend toward a higher rate of complications for patients who weighed less than 15 kg, this finding was not significant (p = 0.35). Conclusions The rate of complications for CA in young children is comparable to rates reported for older children and lower than rates reported for adults. When appropriately indicated, CA should not be omitted from the therapeutic strategy of children younger than 36 months of age.

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Section: Discussionmentioning

confidence: 99%

Section: ©Aans 2014mentioning

confidence: 99%

Complications of cerebral angiography in children younger than 3 years of age

Hoffman¹,

Santillán²,

Rotman³

et al. 2014

PED

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“…Pediatrik olgularda artmış baş çevresi veya fokal nörolojik defisitler ortaya çıkabilir. Yetişkinler ise daha sık baş ağrıları, nöbetler ve fokal nörolojik defisitler vardır [33,36,37]. Bir NGAVF tedavisinin amacı besleyici arterleri ile birlikte ve proksimal drenaj veninin mümkün olduğunca fistüle yakın bölgeden tı-kanmasıdır.…”

Section: Pi̇al Avfunclassified

Pediatrik Konjenital Vaskuler Malformasyonlarda Endovaskuler Tedavi

Çınar¹,

Oran²

2018

Trd Sem

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“…Prior to our report, Weon et al were the only authors to report successful treatment of a pediatric dural AVF with radiosurgery and embolization. 20 Hetts et al 8 recommended that radiosurgery be reserved only for pediatric patients with AVFs and a concomitant AVM nidus, and suggested that radiosurgery was unlikely to induce regression of larger caliber fistulas. In our series, we treated 2 patients with endovascular embolization, surgical clip placement, and radiosurgery, with evidence of complete obliteration at last follow-up evaluation.…”

Section: Stereotactic Radiosurgerymentioning

confidence: 99%

“…Furthermore, radiosurgery has shown promising results in a small subset of patients. 6,10 A review of modern treatment options and clinical outcomes for pediatric cerebral AVFs is lacking, with recent articles often consolidating a multidecade experience 8,20 or showing heavy bias toward endovascular therapy alone. 12,18,19 We sought to review the treatment methodology and clinical outcomes of our institution's multidisciplinary approach to treating these complex cerebrovascular lesions in the modern era.…”

mentioning

confidence: 99%

Multimodal treatment strategies for complex pediatric cerebral arteriovenous fistulas: contemporary case series at Barrow Neurological Institute

Zaidi¹,

Kalani²,

Spetzler³

et al. 2015

PED

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OBJECT Pediatric cerebral arteriovenous fistulas (AVFs) are rare but potentially lethal vascular lesions. Management strategies for these lesions have undergone considerable evolution in the last decade with the advent of new endovascular, surgical, and radiosurgical technologies. This study sought to review current treatment strategies and long-term clinical outcomes at a high-volume cerebrovascular institute. METHODS A retrospective chart review was performed on patients with a diagnosis of cerebral AVF from 1999 to 2012. Patients with carotid-cavernous fistulas, vein of Galen malformations, and age > 18 years were excluded from final analysis. Medical history, surgical and nonsurgical treatment, and clinical outcomes were documented. Pre- and postoperative angiograms were analyzed to assess for obliteration of the fistula. RESULTS Seventeen patients with pial AVFs (29.4%), dural AVFs (64.7%), or mixed pial/dural AVFs (5.9%) were identified. The majority of lesions were paramedian (70.6%) and supratentorial (76.5%). The study population had a mean age of 6.4 years, with a slight male predominance (52.9%), and the most common presenting symptoms were seizures (23.5%), headaches (17.6%), congestive heart failure (11.7%), and enlarging head circumference (11.7%). Among patients who underwent intervention (n = 16), 56.3% were treated with endovascular therapy alone, 6.3% were treated with open surgery alone, and 37.5% required a multimodal approach. Overall, 93.8% of the treated patients received endovascular treatment, 43.8% received open surgery, and 12.5% received radiosurgery. Endovascular embolysates included Onyx (n = 5), N-butyl cyanoacrylate (NBCA; n = 4), or coil embolization (n = 7) with or without balloon assistance (n = 2). Complete angiographic obliteration was achieved in 87.5% at the last follow-up evaluation (mean follow-up 3.1 years). One infant with incomplete AVF obliteration died of congestive heart failure, and 1 patient with complete obliteration died of acute sinus thrombosis, with an overall complication rate of 18.8%. CONCLUSIONS Pediatric cerebral AVFs are challenging neurosurgical lesions. Although advancements in endovascular therapy in the last decade have greatly changed the natural course of this disease, a multidisciplinary approach remains necessary for a large subset of patients. Surgeon experience with a thorough analysis of preoperative imaging is paramount to achieving acceptable clinical outcomes.

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Supratentorial cerebral arteriovenous fistulas (AVFs) in children: review of 41 cases with 63 non choroidal single-hole AVFs

Cited by 123 publications

References 5 publications

Complications of cerebral angiography in children younger than 3 years of age

Complications of cerebral angiography in children younger than 3 years of age

Pediatrik Konjenital Vaskuler Malformasyonlarda Endovaskuler Tedavi

Multimodal treatment strategies for complex pediatric cerebral arteriovenous fistulas: contemporary case series at Barrow Neurological Institute

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