Therapeutic progress in pediatric intracranial dural arteriovenous shunts: A review

Abstract

<jats:p> Pediatric dural arteriovenous shunts (dAVSs) are a rare form of vascular disease: Fewer than 100 cases are reported in PubMed and the understanding of pediatric dAVS is limited. For this study, we searched in PubMed, reviewed and summarized the literature related to pediatric dAVSs. Our review revealed that pediatric dAVSs have an unfavorable natural history: If left untreated, the majority of pediatric dAVSs deteriorate. In a widely accepted classification scheme developed by Lasjaunias et al., pediatric dAVSs are divided into three types: Dural sinus malformation (DMS) with dAVS, infantile dAVS (IDAVS) and adult-type dAVS (ADAVS). In general, the clinical manifestations of dAVS can be summarized as having symptoms due to high-flow arteriovenous shunts, symptoms from retrograde venous drainage, symptoms from cavernous sinus involvement and hydrocephalus, among other signs and symptoms. The pediatric dAVSs may be identified with several imaging techniques; however, the gold standard is digital subtraction angiography (DSA), which indicates unique anatomical details and hemodynamic features. Effectively treating pediatric dAVS is difficult and the prognosis is often unsatisfactory. Transarterial embolization with liquid embolic agents and coils is the treatment of choice for the safe stabilization and/or improvement of the symptoms of pediatric dAVS. In some cases, transumbilical arterial and transvenous approaches have been effective, and surgical resection is also an effective alternative in some cases. Nevertheless, pediatric dAVS can have an unsatisfactory prognosis, even when timely and appropriate treatment is administered; however, with the development of embolization materials and techniques, the potential for improved treatments and prognoses is increasing. </jats:p>

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“…11 En la RM cerebral, se puede detallar la MAV cerebral, pero el gold standard para el diagnóstico es la angiografía, que permite identificar los vasos implicados y los detalles anatómicos de la malformación. 12 El tratamiento de elección es la embolización endovascular mediante neurorradiología intervencionista. El tratamiento ha aumentado la supervivencia, aunque aún se está intentando estimar el pronóstico neurológico de estos pacientes.…”

Progress in research on intracranial multiple�dural�arteriovenous fistulas (Review)

“…In addition to MDAVFs caused by acquired factors, certain intracranial MDAVFs may be congenital in origin, particularly those observed in children. In these cases, MDAVFs are often associated with a developmental malformation in the venous sinus ( 6 ). For instance, Vilela et al ( 27 ) described a 5-year-old patient with MDAVFs who also presented with status epilepticus resulting from severe venous congestive encephalopathy, occlusion of the right sigmoid sinus, absence of cavernous sinuses and stenosis in the left sigmoid sinus-jugular bulb.…”

“…Intracranial pediatric MDAVFs differ from adult intracranial MDAVFs; their clinical manifestations are distinct and may be summarized as symptoms that are caused by high-flow dural arteriovenous fistulas ( 47 ). Affected patients often present with symptoms including hyperdynamic heart failure, increased intracranial pressure, macrocrania, neurocognitive delay and seizures ( 6 ). The symptoms of retrograde venous drainage include hemorrhage and neurological deficits, and symptoms associated with cavernous sinus involvement and hydrocephalus, among other indications ( 6 ).…”

“…Affected patients often present with symptoms including hyperdynamic heart failure, increased intracranial pressure, macrocrania, neurocognitive delay and seizures ( 6 ). The symptoms of retrograde venous drainage include hemorrhage and neurological deficits, and symptoms associated with cavernous sinus involvement and hydrocephalus, among other indications ( 6 ).…”

“…At present, the pathogenesis underlying MDAVF development is not well understood, though there is a consensus that three mechanisms are possible: i) MDAVFs may develop following establishment of a sinus thrombosis involving several sinuses; ii) pre-existing DAVFs may induce sinus thrombosis or venous hypertension, resulting in the formation of MDAVFs; and iii) MDAVFs may be caused by increased angiogenic activity and technical problems that are associated with transvenous embolization ( 4 ). In addition, angiogenic factors, hemodynamic disruption and congenital factors may be involved in MDAVF pathogenesis ( 1 – 3 , 5 , 6 ).…”