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Pediatric spinal arteriovenous malformations and fistulas: a single institute’s experience

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Abstract

Objective

Pediatric spinal vascular diseases are extremely rare. We aimed to evaluate their clinical characteristics and treatment outcomes in our institute.

Design

A total of 10 patient files were retrospectively reviewed, including 3 cases of intramedullary arteriovenous malformations (AVMs), 6 cases of perimedullary arteriovenous fistulas (AVFs), and 1 case of epidural AVF. Clinical features, radiological findings, treatment results, and clinical outcomes were evaluated. The median durations of the radiologic and clinical follow-ups were 17.7 and 107.9 months, respectively.

Results

The male to female ratio was 1:1, with a median age at diagnosis of 9 years. All AVMs were juvenile type, all perimedullary AVFs were high flow types (three type IVb and three type IVc), and one epidural AVF was associated with intradural venous drainage. Most cases (90 %) were located in the cervical spine and conus medullaris. Acute neurological deterioration was identified in five patients; however, bleeding was identified in only one patient. Two cases were surgically treated, seven cases underwent embolization, and one case underwent radiosurgery. Three cases were completely obliterated, and their clinical states were improved (n = 2; 66.7 %) and stationary (n = 1; 33.3 %). Meanwhile, seven cases were incompletely obliterated, and their clinical states were improved (n = 2; 28.6 %), stationary (n = 3; 42.8 %), and aggravated (n = 2; 28.6 %).

Conclusions

Pediatric spinal AVMs and AVFs were mostly complex and high flow types, and complete obliteration could not be satisfactorily achieved. Incompletely treated lesions should be closely followed up because they may worsen.

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Acknowledgments

This research was supported by a grant from the Korea Health Technology R&D Project through the Korea Health Industry Development Institute (KHIDI), funded by the Ministry of Health & Welfare, Republic of Korea (grant number: HI12C0066).

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Authors and Affiliations

  1. Department of Neurosurgery, Seoul National University Hospital, Seoul, South Korea

    Won-Sang Cho, Kyu-Chang Wang, Ji Hoon Phi, Ji Yeoun Lee, Sangjoon Chong, Hyun-Seung Kang, Moon Hee Han & Seung-Ki Kim

  2. Department of Radiology, Seoul National University Hospital, Seoul, South Korea

    Moon Hee Han

  3. Division of Pediatric Neurosurgery, Seoul National University Children’s Hospital, Seoul National University College of Medicine, 101 Daehak-ro, Jongno-gu, Seoul, 03080, South Korea

    Kyu-Chang Wang, Ji Hoon Phi, Ji Yeoun Lee, Sangjoon Chong & Seung-Ki Kim

  4. Department of Anatomy, Seoul National University College of Medicine, Seoul, South Korea

    Ji Yeoun Lee

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  1. Won-Sang Cho
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  2. Kyu-Chang Wang
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  3. Ji Hoon Phi
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  7. Moon Hee Han
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  8. Seung-Ki Kim
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Corresponding author

Correspondence to Seung-Ki Kim.

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This study was approved by the Seoul National University Hospital Institutional Review Board.

Conflict of interest

The authors have no conflict of interest to disclose.

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Cho, WS., Wang, KC., Phi, J.H. et al. Pediatric spinal arteriovenous malformations and fistulas: a single institute’s experience. Childs Nerv Syst 32, 811–818 (2016). https://doi.org/10.1007/s00381-016-3035-0

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  • DOI: https://doi.org/10.1007/s00381-016-3035-0

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