Spontaneous resolution of symptoms in an infant with a congenital dural caroticocavernous fistula

Therapeutic progress in pediatric intracranial dural arteriovenous shunts: A review

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.

Indirect internal carotid-cavernous fistula in infancy

A 4-month-old male infant with proptosis and episcleral injection initially thought to have orbital inflammation was found to have an indirect carotid-cavernous sinus fistula. He was treated conservatively without worsening of symptoms. The authors report the first case of indirect carotid-cavernous sinus fistula in an infant originating from the internal carotid artery.

Pediatric intracranial arteriovenous shunts: a global overview

INTRODUCTION

Cerebral arteriovenous shunts (CAVS) in the pediatric population cannot be compared to those in adults as they present different anatomical, physiological, and pathological characteristics concerning the arterial and venous vasculature and the cerebrospinal fluid physiology. These lesions develop in a maturing brain, of which expression is difficult to assess, with a potential for recovery different from that in adults.

DISCUSSION

Their impact on the brain will be different in the antenatal period, in neonates, in infants, and in children, with variable symptoms according to each age group. We review different classifications of pediatric CAVS (according to the anatomical space in which they develop, their type and architecture, and the age at which they reveal), describe their evolution, and discuss the current role of endovascular treatment in the management of these vascular lesions.

Neonatal dural arteriovenous fistula at the confluence presenting with paralysis of the orbicularis oris muscle

A male neonate presented a dural arteriovenous fistula (DAVF) at the confluence with paralysis of the orbicularis oris muscle. The interesting features in our case were the clinical symptoms (orbicularis oris muscle paralysis at birth), angioarchitecture (high-flow arteriovenous shunts at the confluence) and the size and hemodynamic flow (mid-sized venous pouch) of the fistula. Additionally, the embolization technique (i.e., occipital artery approach, closing shunts with pure glue) automatically resulted in the immediate and complete closure of accessory feeders without any additional treatment, and the midterm clinical outcome was good. We succeeded improving the symptoms of a neonate with a congenital high-flow DAVF by closing a fistula using a small amount of glue.

Endovascular treatment of congenital carotid-cavernous fistulas in infancy

Congenital dural arteriovenous fistulas have been infrequently described in pediatric population and they generally affect the transverse, sigmoid, straight or sagittal sinuses. Congenital carotid-cavernous fistulas in infancy are considered very rare and to our knowledge, only four cases have been reported in literature. Currently, the preferred treatment is endovascular embolization through trans-arterial route. We review the literature on congenital carotid cavernous fistulas in infancy focusing on the endovascular treatment of this rare entity and present our experience.

Successful treatment of dural AV fistulas by manual compression—a matter of perseverance

A noninvasive treatment of an occipital dural AV fistula by external compression of the carotid artery and jugular vein is documented. The late successful occlusion of the malformation after almost 19 months and a total of 13,216 single manual compressions shows that fistula occlusion can be achieved late and is dependent on careful performance of the maneuver.

Spontaneous occlusion of a bilateral post traumatic carotid cavernous fistula

SUMMARY

This report describes a rare occurrence of spontaneous closure of direct bilateral carotid cavernous fistula in a 62-year-old woman who had head injury. This was confirmed by clinical examination and subsequent angiogram. Partial thrombosis of bilateral superior ophthalmic veins was observed in the initial arteriography. This finding may be useful in prediction of spontaneous cure of carotid cavernous fistulas.

The parasellar region of human infants: cavernous sinus topography and surgical approaches

OBJECT

In this study the authors analyze the peculiarities of the parasellar anatomy and the topography of surgical approaches to the parasellar region (PSR) in human infants.

METHODS

Forty-nine specimens of the PSR obtained at autopsy were studied using microdissection and histological analysis. Important distances between anatomical landmarks were measured with the aid of a dissecting microscope. One serially sectioned specimen was three-dimensionally reconstructed and analyzed on the computer screen by using the authors' new episcopic reconstruction technique.

CONCLUSIONS

The anatomy of the infant PSR differs distinctly from that of the adult. The parasellar portion of the internal carotid artery (ICA) does not form a siphon, but takes a straight course, and the venous pathways as well as the cranial and sympathetic nerves have different topographical relationships. Analyses of surgical approaches demonstrate that, in young children, the anterolateral approach can be used to reach the pterygopalatine compartment, the superior ophthalmic vein, and those pathological processes that extend from the orbit into the PSR. The approach via Parkinson's triangle can be used in 45% of cases to access the pathological processes that occur in the voluminous space above and behind the posterior flexure of the parasellar ICA. Taking this route, sympathetic nerve fibers passing through the PSR are not at risk, but some arterial branches that run within the lateral wall of the sinus can complicate this approach. This study presents a guideline that can assist radiologists and neurosurgeons in the planning and performance of interventions within the PSR of neonates and young children.

The parasellar region of human infants: cavernous sinus topography and surgical approaches

Object

In this study the authors analyze the peculiarities of the parasellar anatomy and the topography of surgical approaches to the parasellar region (PSR) in human infants.

Methods

Forty-nine specimens of the PSR obtained at autopsy were studied using microdissection and histological analysis. Important distances between anatomical landmarks were measured with the aid of a dissecting microscope. One serially sectioned specimen was three-dimensionally reconstructed and analyzed on the computer screen by using the authors' new episcopic reconstruction technique.

The anatomy of the infant PSR differs distinctly from that of the adult. The parasellar portion of the internal carotid artery (ICA) does not form a siphon, but takes a straight course, and the venous pathways as well as the cranial and sympathetic nerves have different topographical relationships. Analyses of surgical approaches demonstrate that, in young children, the anterolateral approach can be used to reach the pterygopalatine compartment, the superior ophthalmic vein, and those pathological processes that extend from the orbit into the PSR. The approach via Parkinson's triangle can be used in 45% of cases to access the pathological processes that occur in the voluminous space above and behind the posterior flexure of the parasellar ICA. Taking this route, sympathetic nerve fibers passing through the PSR are not at risk, but some arterial branches that run within the lateral wall of the sinus can complicate this approach.

Conclusions

This study presents a guideline that can assist radiologists and neurosurgeons in the planning and performance of interventions within the PSR of neonates and young children.