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Child's Nervous System

, Volume 26, Issue 10, pp 1345–1358 | Cite as

Endovascular management of arteriovenous malformations and other intracranial arteriovenous shunts in neonates, infants, and children

  • Alejandro Berenstein
  • Rafael Ortiz
  • Yasunari Niimi
  • Lucas Elijovich
  • Johanna Fifi
  • Mary Madrid
  • Saadi Ghatan
  • Walter Molofsky
Special Annual Issue

Abstract

Purpose

We discuss the management of cerebral arteriovenous shunts in neonates, infants, and children, with emphasis on our experience with pediatric cerebral arteriovenous malformations (AVMs). The management of vein of Galen malformations is discussed in a separate chapter.

Methods

An all-inclusive retrospective chart review of the endovascular surgery operative record database at the Hyman Newman Institute for Neurology and Neurosurgery at Roosevelt Hospital in NYC was conducted. All consecutive pediatric patients (newborn to 18 years of age) with intracranial arteriovenous shunts who presented from January 1, 2004 to June 16, 2009 were included.

Results

A total of 151 consecutive pediatric patients with intracranial arteriovenous shunts were evaluated from the period of January 1, 2004 to June 16, 2009. This included 56 patients with vein of Galen malformations, 48 cerebral AVMs, 11 patients with pial arteriovenous fistulae, six patients with dural arteriovenous malformations, and 30 patients with mixed intracranial vascular malformations. Forty-four patients underwent a total of 163 endovascular embolizations. The complications rate for endovascular embolizations was 6.7% (11 in 163), 5.5% with temporary complications and 1.2% with permanent complications. The mortality rate for the group of patients (excluding patients with vein of Galen malformations) that underwent endovascular embolizations was 0.0%.

Conclusions

Careful clinical observation and timely intervention are important in the management of pediatric patients with intracranial arteriovenous shunts. Trans-arterial endovascular embolization with liquid embolic agents is the treatment of choice for safe stabilization and/or improvement of symptoms in the group of pediatric patients with intracranial arteriovenous malformations.

Keywords

Pediatric Cerebral AVM Pial arteriovenous malformation Intracranial arteriovenous shunt 

References

  1. 1.
    Bhattacharya J, Luo C, Suh D, Alvarez H, Rodesch G, Lausjaunias P (2001) Wyburn–Mason or Bonnet–Dechaume–Blanc as cerebrofacial arteriovenous metameric syndrome (CAMS)—a new concept and new classification. Interv Neuroradiol 7:5–17PubMedGoogle Scholar
  2. 2.
    Hladky J, Lejeune J, Blond S, Pruvo J, Dhellemmes P (1994) Cerebral arteriovenous malformations in children: report on 62 cases. Childs Nerv Syst 10:328–333CrossRefPubMedGoogle Scholar
  3. 3.
    Katsaridis V, Papagiannaki C, Aimar E (2008) Curative embolization of cerebral arteriovenous malformations (AVM) with Onyx in 101 patients. Neuroradiology 50(7):589–597CrossRefPubMedGoogle Scholar
  4. 4.
    Lausjaunias P, Ter Brugge KG, Berenstein A (2006) Introductions and General Comments Regarding Pediatric Intracranial Arteriovenous Shunts. Surgical Neuroangiography. Volume 3. Second Edition. BerlinGoogle Scholar
  5. 5.
    Lausjaunias P, Ter Brugge KG, Berenstein A (2004) Technical Aspects of Surginal Neuroangiography. Surgical Neuroangiography. Volume 2.2. Second Edition. BerlinGoogle Scholar
  6. 6.
    Mahadevan J, Ozanne A, Yoshida WY, Alvarez H, Rodesch G (2004) Hereditary haemorrhagic telangiectasia cerebrospinal localization in adults and children. Review of 39 cases. Interv Neuroraidol 10:27–35Google Scholar
  7. 7.
    Ozanne A, Alvarez H, Krings T, Lausjaunias P (2007) Pediatric neurovascular malformations: vein of Galen arteriovenous malformations (VGAM), pial arteriovenous malformations (pial AVM), dural sinus malformations (DSM). J Neuroradiol 34(3):145–166CrossRefPubMedGoogle Scholar
  8. 8.
    Pan D, Kuo Y, Guo W, Chung W, Wu H, Liu K, Chang Y, Wang L, Wong T (2008) Gamma knife surgery for cerebral arteriovenous malformations in children: a 13-year experience. J Neurosurg Pediatr 2(3):229CrossRefGoogle Scholar
  9. 9.
    Sanchez-Mejia R, Chennupati S, Gupta N, Fullerton H, Young W, Lawton M (2006) Superior outcomes in children compared with adults after microsurgical resection of brain arteriovenous malformations. J Neurosurg 105(2):82–87PubMedGoogle Scholar
  10. 10.
    Shin M, Kawamoto S, Kurita H, Tago M, Sasaki T, Morita A, Ueki K, Kirino T (2002) Retrospective analysis of a 10-year experience of stereotactic radio surgery for arteriovenous malformations in children and adolescents. J Neurosurg 97:779–784CrossRefPubMedGoogle Scholar
  11. 11.
    Smith L, Barth P, Stam F, Valk J (1981) Congenital multiple angiomatosis with brain involvement. Childs Brain 8:461–467Google Scholar
  12. 12.
    Spetzler R, Martin N (1986) A proposed grading system for arteriovenous malformations. J Neurosurg 65(4):476–483CrossRefPubMedGoogle Scholar
  13. 13.
    Willinsky R, Lausjaunias P, Ter Brugge K, Burrows P (1990) Multiple cerebral arteriovenous malformations (AVMs): review of our experience from 203 patients with cerebral vascular lesions. Neuroradiology 32:207–210CrossRefPubMedGoogle Scholar

Copyright information

© Springer-Verlag 2010

Authors and Affiliations

  • Alejandro Berenstein
    • 1
  • Rafael Ortiz
    • 1
  • Yasunari Niimi
    • 1
  • Lucas Elijovich
    • 1
  • Johanna Fifi
    • 1
  • Mary Madrid
    • 1
  • Saadi Ghatan
    • 2
  • Walter Molofsky
    • 3
  1. 1.Center for Endovascular SurgeryRoosevelt HospitalNew YorkUSA
  2. 2.Pediatric NeurosurgeryRoosevelt HospitalNew YorkUSA
  3. 3.Pediatric NeurologyRoosevelt HospitalNew YorkUSA

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