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Borges de Almeida G, Pamplona J, Baptista M, Carvalho R, Conceição C, Lopes da Silva R, Sagarribay A, Reis J, Fragata I. Endovascular Treatment of Brain Arteriovenous Malformations in Pediatric Patients: A Single Center Experience and Review of the Literature. J Neurol Surg A Cent Eur Neurosurg 2024; 85:361-370. [PMID: 37494960 DOI: 10.1055/s-0043-1770356] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/28/2023]
Abstract
BACKGROUND Brain arteriovenous malformations (bAVMs) are abnormal vascular connections with direct arteriovenous shunts, generally symptomatic in the adult life. However, a small number of bAVMs may manifest in pediatric patients, with higher bleeding risk and mortality rates when compared to adults. The purpose of this study is to review our experience with endovascular treatment of bAVMs in pediatric patients. METHODS This is a retrospective analysis of all bAVMs in pediatric patients (0-18 years) who underwent diagnostic digital subtraction angiography (DSA) at our institution from January 2010 to June 2021. RESULTS Twenty-six patients met the inclusion criteria, of which 12 underwent endovascular treatment. Treated patients had a mean age of 10.25 years and 58% were females. Complete angiographic exclusion was achieved in five (42%) patients with endovascular treatment. Five patients with residual bAVM after embolization needed adjuvant therapy with surgery (n = 3) or stereotactic radiosurgery (SRS; n = 2). Two patients are still undergoing embolization sessions. Procedure-related complications occurred in two patients (17%) and included small vessel perforation and an occipital ischemic stroke. Two patients showed bAVM recurrence on follow-up (17%) and subsequently underwent SRS (n = 1) or surgery (n = 1), both resulting in complete bAVM exclusion. All patients had a modified Rankin scale (mRS) score of 0 to 2 on follow-up. CONCLUSION Our experience supports the effectiveness and safety of endovascular treatment of bAVM in selected pediatric patients. A multidisciplinary approach combining surgery and SRS is warranted to achieve higher complete bAVM obliteration rates. Long-term follow-up is important as these lesions may show recurrence over time, especially in the pediatric population.
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Affiliation(s)
| | - Jaime Pamplona
- Department of Neuroradiology, Centro Hospitalar e Universitário de Lisboa Central, Lisboa, Portugal
- NOVA Medical School, Universidade Nova de Lisboa, Portugal
| | - Mariana Baptista
- Department of Neuroradiology, Centro Hospitalar e Universitário de Lisboa Central, Lisboa, Portugal
- NOVA Medical School, Universidade Nova de Lisboa, Portugal
| | - Rui Carvalho
- Department of Neuroradiology, Centro Hospitalar e Universitário de Lisboa Central, Lisboa, Portugal
- NOVA Medical School, Universidade Nova de Lisboa, Portugal
| | - Carla Conceição
- Department of Neuroradiology, Centro Hospitalar e Universitário de Lisboa Central, Lisboa, Portugal
| | - Rita Lopes da Silva
- Department of Pediatric Neurology, Centro Hospitalar e Universitário de Lisboa Central, Lisboa, Portugal
| | - Amets Sagarribay
- Department of Neurosurgery, Centro Hospitalar e Universitário de Lisboa Central, Lisboa, Portugal
| | - João Reis
- Department of Neuroradiology, Centro Hospitalar e Universitário de Lisboa Central, Lisboa, Portugal
| | - Isabel Fragata
- Department of Neuroradiology, Centro Hospitalar e Universitário de Lisboa Central, Lisboa, Portugal
- NOVA Medical School, Universidade Nova de Lisboa, Portugal
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2
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Devarajan A, Goldman D, Shigematsu T, Berenstein A, Fifi JT. Vein of Galen Malformations. Neurosurg Clin N Am 2024; 35:363-374. [PMID: 38782529 DOI: 10.1016/j.nec.2024.02.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/25/2024]
Abstract
Significant efforts have been made over the last few decades to improve the diagnosis and management of patients with vein of Galen malformations (VOGMs). The mainstays of treatment remain focused on primary endovascular management by staged transarterial embolizations with adjunctive use of transvenous embolization, medical therapy, and neurosurgical intervention for symptom control in select patients. Innovation in endovascular technology and techniques as well as promising new genomic research elucidating potential therapeutic targets hold significant promise for the future of VOGM treatment.
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Affiliation(s)
- Alex Devarajan
- Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Daryl Goldman
- Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Tomoyoshi Shigematsu
- Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Alejandro Berenstein
- Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Johanna T Fifi
- Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, NY, USA.
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3
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Devarajan A, Schupper AJ, Rossitto CP, Bonet JM, Sorscher M, Vasan V, Morgenstern PF, Ghatan S, Shigematsu T, Berenstein A, Fifi JT. Use of a mini balloon microcatheter to facilitate penetration of fine vascular networks and curative embolization in vein of Galen malformations. J Neurointerv Surg 2024; 16:698-705. [PMID: 38085160 DOI: 10.1136/jnis-2023-020577] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2023] [Accepted: 07/07/2023] [Indexed: 06/19/2024]
Abstract
Background Patients with vein of Galen malformations (VOGMs) can develop fine angiogenic networks with fistulous connections to the precursor of the vein of Galen. In these cases, transarterial embolization (TAE) with liquid embolic agents (LEAs) is challenging due to reflux in the pedicle leading to the network, causing poor penetration. Transvenous approaches carry a risk of hemorrhage from pathologic vasculature. Dual-lumen balloon microcatheters like the Scepter Mini (Microvention, Aliso Viejo, CA) improve distal pedicle access, preventing reflux. Objective Here, we report on the use of the Scepter Mini for TAE of angiogenic VOGM. Methods A single-institution retrospective chart review identified all VOGMs treated with Scepter Mini microcatheters. Clinical data, angioarchitecture, and technical parameters were reviewed. Results 17 Scepter Mini catheters were used in 12 embolization procedures of 7 patients with VOGM at a median age of 2.1 years. Patients presented with hydrocephalus (100%) and gross motor and speech delays (57.1%). Networks developed extra-axially into the subependymal zone fed by posterior choroidal, posterior cerebral, and thalamoperforator arteries. Posterior choroidal branches (n=7/17, 41.2%) were most frequently catheterized to achieve distal access to the network. Embolization with Onyx-18 and significant network penetration occurred in 17/17 uses. Near tip entrapment with LEA cast displacement occurred in 1/17 uses. Another patient experienced postprocedural intraventricular hemorrhage requiring a third ventriculostomy without permanent neurologic deficit. Conclusion The Scepter Mini provided excellent distal access with penetration to the fistula and extra-axial network reduction with few complications. The Scepter Mini provides a means for successful treatment of technically challenging angiogenic VOGM.
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Affiliation(s)
- Alex Devarajan
- Neurosurgery, Icahn School of Medicine at Mount Sinai, New York City, New York, USA
| | - Alexander J Schupper
- Neurosurgery, Icahn School of Medicine at Mount Sinai, New York City, New York, USA
| | - Christina P Rossitto
- Neurosurgery, Icahn School of Medicine at Mount Sinai, New York City, New York, USA
| | - Jessica M Bonet
- Neurosurgery, Icahn School of Medicine at Mount Sinai, New York City, New York, USA
| | - Michelle Sorscher
- Neurosurgery, Icahn School of Medicine at Mount Sinai, New York City, New York, USA
| | - Vikram Vasan
- Neurosurgery, Icahn School of Medicine at Mount Sinai, New York City, New York, USA
| | - Peter F Morgenstern
- Neurosurgery, Icahn School of Medicine at Mount Sinai, New York City, New York, USA
| | - Saadi Ghatan
- Neurosurgery, Icahn School of Medicine at Mount Sinai, New York City, New York, USA
| | - Tomoyoshi Shigematsu
- Neurosurgery, Icahn School of Medicine at Mount Sinai, New York City, New York, USA
| | - Alejandro Berenstein
- Neurosurgery, Icahn School of Medicine at Mount Sinai, New York City, New York, USA
| | - Johanna T Fifi
- Neurosurgery, Icahn School of Medicine at Mount Sinai, New York City, New York, USA
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4
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Chen KS, Williams DD, Iacobas I, McClugage SG, Gadgil N, Kan P. Spontaneous thrombosis of high flow pediatric arteriovenous fistulae: Case series of two patients and a comprehensive literature review. Childs Nerv Syst 2024; 40:1405-1414. [PMID: 38085366 DOI: 10.1007/s00381-023-06241-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2023] [Accepted: 11/21/2023] [Indexed: 04/19/2024]
Abstract
Pediatric pial arteriovenous shunts in the brain and spine are challenging to understand because of low incidence, variable presentation, and associations with genetic syndromes. What is known about their natural history comes from reviews of small series. To better understand the natural history and role for intervention, two cases are presented followed by a review of the literature. In the first case, an infant with a prior history of intracranial hemorrhage from a ruptured pial fistula returns for elective embolization for a second pial fistula which was found to be spontaneously thrombosed 2 weeks later. In the second case, a 5-year-old with a vertebro-vertebral fistula, identified on work up for a heart murmur and documented with diagnostic angiography, is brought for elective embolization 6 weeks later where spontaneous thrombosis is identified. In reviewing the literature on pediatric single-hole fistulae of the brain and spine, the authors offer some morphologic considerations for identifying which high-flow fistulae may undergo spontaneous thrombosis to decrease the potentially unnecessary risk associated with interventions in small children.
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Affiliation(s)
- Karen S Chen
- Edward B. Singleton Department of Radiology and Department of Neurosurgery, Texas Children's Hospital, Baylor College of Medicine, 6701 Fannin St, Suite 470, Houston, TX, 77030, USA.
| | - Daniel Davila Williams
- Department of Neurology, Texas Children's Hospital, Baylor College of Medicine, 6701 Fannin St, Suite 1250, Houston, TX, 77030, USA
| | - Ionela Iacobas
- Department of Pediatrics, Baylor College of Medicine, Vascular Anomalies Center at Texas Children's Cancer and Hematology Centers, Texas Children's Hospital, 6701 Fannin St, Suite 1510, Houston, TX, 77030, USA
| | - Samuel G McClugage
- Department of Neurosurgery, Texas Children's Hospital, Baylor College of Medicine, 6701 Fannin St, Suite 1230, Houston, TX, 77030, USA
| | - Nisha Gadgil
- Department of Neurosurgery, Texas Children's Hospital, Baylor College of Medicine, 6701 Fannin St, Suite 1230, Houston, TX, 77030, USA
| | - Peter Kan
- Department of Neurosurgery, University of Texas Medical Branch, 1005 Harborside Dr, 5th floor, Galveston, TX, 77555, USA
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5
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Li J, Ji Z, Yu J, Ren J, Yang F, Bian L, Zhi X, Li G, Zhang H. Angioarchitecture and prognosis of pediatric intracranial pial arteriovenous fistula. Stroke Vasc Neurol 2023; 8:292-300. [PMID: 36609545 PMCID: PMC10512084 DOI: 10.1136/svn-2022-001979] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2022] [Accepted: 12/04/2022] [Indexed: 01/09/2023] Open
Abstract
OBJECTIVE Pial arteriovenous fistulas (PAVFs) are rare and mostly observed in children. However, the overall angioarchitecture, clinical features, treatments and long-term prognosis for pediatric patients remain unclear. METHODS Clinical data of consecutive 42 pediatric PAVFs were documented and analysed. According to the differences of age distribution and clinical features, they were split into a younger group (≤3 years old; 20 cases) and an older group (3-14 years old; 22 cases). RESULTS Their mean age was 4.9±3.9 years, and the mean preoperative modified Rankin Scale (mRS) score was 1.64±1.57. Fourteen patients (33.3%) were asymptomatic, followed by epilepsy (21.4%), intracranial haemorrhage (16.7%), hydrocephalus (9.5%), developmental delay (7.1%), intermittent headache (7.1%) and congestive heart failure (4.8%). Annual bleeding rate and rebleeding rate before treatment reached 3.86% and 3.17%. Poor venous drainage including sinus dynamic obstruction (21 cases, 50.0%) and sinus occlusion (17 cases, 40.48%) were found with high frequency among these patients. Finally, 33 cases were cured (78.57%), and 4 cases faced surgery-related complications (9.52%). During 24-140 months' follow-up, the mean mRS score reduced to 0.57±0.40. However, only 22 cases (52.38%) recovered to absolutely normal, and poor venous drainage was the risk factor for patients' incomplete recovery (p=0.028, Exp(B)=14.692, 95% CI 1.346 to 160.392). Compared with the older group, younger group showed more chronic symptoms, more secondary pathological changes, more times treatment and worse prognosis (p=0.013, 0.002, 0.000 and 0.032, respectively). CONCLUSIONS Pediatric PAVF has different angioarchitectures, clinical features and prognoses in different age groups. Poor venous drainage is an important factor leading to poor prognosis, and it accounts for incomplete recovery in nearly half of patients.
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Affiliation(s)
- Jingwei Li
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, China
- National Center for Neurological Disorders, Beijing, China
- China International Neuroscience Institute, Beijing, China
| | - Zhenlong Ji
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, China
- Department of Neurosurgery, Affiliated Hospital of Beihua University, Jilin province, China
| | - Jiaxing Yu
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, China
- National Center for Neurological Disorders, Beijing, China
- China International Neuroscience Institute, Beijing, China
| | - Jian Ren
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, China
- National Center for Neurological Disorders, Beijing, China
- China International Neuroscience Institute, Beijing, China
| | - Fan Yang
- Department of Neurosurgery, Beijing United Family Hospital, Beijing, China
| | - Lisong Bian
- Department of Neurosurgery, Beijing Haidian Hospital, Beijing, China
| | - Xinglong Zhi
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, China
- National Center for Neurological Disorders, Beijing, China
- China International Neuroscience Institute, Beijing, China
| | - Guilin Li
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, China
- National Center for Neurological Disorders, Beijing, China
- China International Neuroscience Institute, Beijing, China
| | - Hongqi Zhang
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, China
- National Center for Neurological Disorders, Beijing, China
- China International Neuroscience Institute, Beijing, China
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Sabrina C, Laura M, Sabrina S, Giacomo T, Nicoletta M, Elena P, Francesco C, Eugenio B. Expect the unexpected: a case of spontaneous thrombosis of a pial arteriovenous fistula in a preterm newborn with review of the literature. Childs Nerv Syst 2023; 39:793-799. [PMID: 36161521 PMCID: PMC10024657 DOI: 10.1007/s00381-022-05652-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2022] [Accepted: 08/13/2022] [Indexed: 11/29/2022]
Abstract
INTRODUCTION Pial arteriovenous fistulas (pAVF) are rare vascular malformations, especially in children and newborns. In neonates, the most common symptom is congestive heart failure. CASE PRESENTATION We report a case of an asymptomatic preterm newborn incidentally diagnosed with pAVF during a routine cranial ultrasound (cUS) on the third day of life. Cerebral magnetic resonance (MRI) confirmed the diagnosis. A wait-and-see approach was chosen by the multidisciplinary team. The cUS and the MRI on day 14 of life showed the spontaneous resolution of the lesion. CONCLUSIONS This case underlines the challenges in identifying pAVF in the first weeks of life and demonstrates a possible positive outcome for affected neonates.
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Affiliation(s)
- Congedi Sabrina
- University of Padua, Department of Women's and Children's Health, Padova University Hospital, Unit of Neonatal Intensive Care Unit, Division Women's and Children's Health , Padua, Italy.
| | - Moschino Laura
- University of Padua, Department of Women's and Children's Health, Padova University Hospital, Unit of Neonatal Intensive Care Unit, Division Women's and Children's Health , Padua, Italy
| | - Salvadori Sabrina
- University of Padua, Department of Women's and Children's Health, Padova University Hospital, Unit of Neonatal Intensive Care Unit, Division Women's and Children's Health , Padua, Italy
| | - Talenti Giacomo
- Neuroradiology Unit, Padova University Hospital, Padua, Italy
| | - Mainini Nicoletta
- University of Padua, Department of Women's and Children's Health, Padova University Hospital, Unit of Neonatal Intensive Care Unit, Division Women's and Children's Health , Padua, Italy
| | - Priante Elena
- University of Padua, Department of Women's and Children's Health, Padova University Hospital, Unit of Neonatal Intensive Care Unit, Division Women's and Children's Health , Padua, Italy
| | - Causin Francesco
- Interventional Neuroradiology, Padova University Hospital, Padua, Italy
| | - Baraldi Eugenio
- University of Padua, Department of Women's and Children's Health, Padova University Hospital, Unit of Neonatal Intensive Care Unit, Division Women's and Children's Health , Padua, Italy
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Berestov V, Seleznev P, Obedinskaya N, Korostyshevskaya A, Gofer J, Bondarenko I, Kiselev R, Krasilnikov S, Brusyanskaya A, Orlov K. Huge cerebral pial arteriovenous fistula in a newborn: illustrative case. JOURNAL OF NEUROSURGERY. CASE LESSONS 2022; 4:CASE22294. [PMID: 36254355 PMCID: PMC9576030 DOI: 10.3171/case22294] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/18/2022] [Accepted: 09/09/2022] [Indexed: 11/06/2022]
Abstract
BACKGROUND Pediatric arteriovenous malformations (AVMs) and pial/dural arteriovenous fistulas (AVFs) are rare but life-threatening complications that can lead to congestive heart failure and hemorrhagic stroke in newborns and pediatric patients. The pronounced shunting in these conditions is associated with early complications and necessitates aggressive surgical management. Here, the authors describe endovascular treatment of an atypical cerebral pial AVF in a newborn. OBSERVATIONS This AVF formed direct communication between a major cerebral artery (basilar artery) and a large draining vein (dilated deep cerebral vein). The authors performed earlier subtotal embolization of the AVF using 0.020-inch coils, which led to progressive thrombosis of the fistula with restoration of normal arterial blood flow. The patient was discharged 18 days after surgery, examination at 1.5 and 6 months showed magnetic resonance imaging signs of blood flow absence through the fistula and satisfactory condition of the infant without physical and mental developmental delay. LESSONS Subtotal coiling of a high-flow pial AVF in a newborn can result in a good clinical outcome.
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Affiliation(s)
- Vadim Berestov
- Department of Endovascular Neurosurgery, Federal Center of Brain Research and Neurotechnologies, Federal Biomedical Agency of Russian Federation, Moscow, Russian Federation,Oncology and Neurosurgery Center, Academician E.N. Meshalkin National Medical Research Center, Ministry of Healthcare of Russian Federation, Novosibirsk, Russian Federation; and
| | - Pavel Seleznev
- Oncology and Neurosurgery Center, Academician E.N. Meshalkin National Medical Research Center, Ministry of Healthcare of Russian Federation, Novosibirsk, Russian Federation; and
| | - Natalya Obedinskaya
- International Tomography Center, Siberian Branch of Russian Academy of Sciences, Novosibirsk, Russian Federation
| | - Alexandra Korostyshevskaya
- International Tomography Center, Siberian Branch of Russian Academy of Sciences, Novosibirsk, Russian Federation
| | - Julia Gofer
- Oncology and Neurosurgery Center, Academician E.N. Meshalkin National Medical Research Center, Ministry of Healthcare of Russian Federation, Novosibirsk, Russian Federation; and
| | - Ilya Bondarenko
- Oncology and Neurosurgery Center, Academician E.N. Meshalkin National Medical Research Center, Ministry of Healthcare of Russian Federation, Novosibirsk, Russian Federation; and
| | - Roman Kiselev
- Oncology and Neurosurgery Center, Academician E.N. Meshalkin National Medical Research Center, Ministry of Healthcare of Russian Federation, Novosibirsk, Russian Federation; and
| | - Sergey Krasilnikov
- Oncology and Neurosurgery Center, Academician E.N. Meshalkin National Medical Research Center, Ministry of Healthcare of Russian Federation, Novosibirsk, Russian Federation; and
| | - Anna Brusyanskaya
- Department of Endovascular Neurosurgery, Federal Center of Brain Research and Neurotechnologies, Federal Biomedical Agency of Russian Federation, Moscow, Russian Federation
| | - Kirill Orlov
- Department of Endovascular Neurosurgery, Federal Center of Brain Research and Neurotechnologies, Federal Biomedical Agency of Russian Federation, Moscow, Russian Federation,Oncology and Neurosurgery Center, Academician E.N. Meshalkin National Medical Research Center, Ministry of Healthcare of Russian Federation, Novosibirsk, Russian Federation; and
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8
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Fifi JT, Bazil MJ, Matsoukas S, Shigematsu T, Sorscher M, Berenstein A. Evolution of transvenous embolization in vein of Galen malformation: case series and review of the literature. J Neurointerv Surg 2022; 15:579-583. [PMID: 35835461 DOI: 10.1136/jnis-2022-019121] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2022] [Accepted: 06/28/2022] [Indexed: 11/03/2022]
Abstract
BACKGROUND Treatment of vein of Galen malformations (VOGMs) has improved greatly since the inception of endovascular treatment. Transvenous embolization (TVE) is an attractive option to achieve complete obliteration. OBJECTIVE To review the literature on TVE of VOGM and then analyze our practice's unique experience and evolving treatment strategies over 30 years. METHODS A retrospective review of our clinical database for patients with the diagnosis of VOGM treated between January 2004 and August 2021 was performed. A literature review of 49 relevant articles was also carried out. RESULTS TVE in VOGM has evolved with initial introduction as a transtorcular (TT) approach, which then lost favor to transarterial embolization (TAE). TAE has been considered the more favorable approach in most high-volume centers. In more recent times, the transvenous embolization (TVE) approach has been revisited as a last treatment to achieve a cure after a series of TAE treatments. We presently favor beginning treatment with staged TAE to reduce flow to the lesion and, importantly, shrink the draining vein. This then allows for the performance of TVE with the Chapot pressure cooker technique (CPCT) with coils and liquid embolic embolization. CONCLUSIONS TT TVE itself carries a high degree of risk and is most highly associated with long-term morbidities and mortality. Traditional transfemoral/transjugular TVE approaches are safe and effective in simple fistulas with a small venous pouch; however, we believe that the CPCT is the safest technique as a last-stage treatment for its security in avoiding reflux and obtaining occlusion of the small perforators.
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Affiliation(s)
- Johanna T Fifi
- Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, New York, USA .,Department of Neurology, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Maximilian Jeremy Bazil
- Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Stavros Matsoukas
- Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Tomoyoshi Shigematsu
- Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Michelle Sorscher
- Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Alejandro Berenstein
- Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, New York, USA
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9
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Gaztanaga W, Luther E, McCarthy D, Chamyan G, Wang S, Ragheb J. Giant, symptomatic mixed vascular malformation containing a cavernoma, developmental venous anomaly, and capillary telangiectasia in a 19-month-old infant. Childs Nerv Syst 2022; 38:1005-1009. [PMID: 34595586 DOI: 10.1007/s00381-021-05358-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2021] [Accepted: 09/05/2021] [Indexed: 10/20/2022]
Abstract
Intracranial mixed vascular malformations (MVMs) are defined as any combination of a developmental venous anomaly (DVA), cerebral cavernous malformation (CCM), capillary telangiectasia (CTG), or arteriovenous malformation (AVM) within a single, contiguous lesion. However, most MVMs described in the literature contain only 2 pathologically discrete malformations; juxtaposition of 3 or more abnormalities in a single lesion remains exceedingly rare. We present the case of a 19-month-old female with new onset focal seizures and a 4-cm right basal ganglia lesion initially believed to be an embryonal neoplasm. She subsequently underwent gross total resection (GTR) of the lesion via a transsylvian-transinsular approach. Intraoperatively, the lesion appeared to be heterogenous and highly vascular, with areas of purplish-gray friable tissue. Pathology confirmed the lesion to be a MVM containing a CCM, CTG, and a DVA. This appears to be the first reported case of such a lesion confirmed on pathology in the literature.
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Affiliation(s)
- Wendy Gaztanaga
- Department of Neurosurgery, University of Miami Miller School of Medicine, Miami, FL, USA.
| | - Evan Luther
- Department of Neurosurgery, University of Miami Miller School of Medicine, Miami, FL, USA
| | - David McCarthy
- Department of Neurosurgery, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Gabriel Chamyan
- Department of Pathology, Nicklaus Children's Hospital, Miami, FL, USA
| | - Shelly Wang
- Department of Neurosurgery, University of Miami Miller School of Medicine, Miami, FL, USA
- Department of Neurosurgery, Nicklaus Children's Hospital, Miami, FL, USA
| | - John Ragheb
- Department of Neurosurgery, University of Miami Miller School of Medicine, Miami, FL, USA
- Department of Neurosurgery, Nicklaus Children's Hospital, Miami, FL, USA
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10
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Rodriguez-Calienes A, Bustamante-Paytan D, Camacho-Caballero K, Mayoria-Vargas A, Rodríguez-Varela R, Saal-Zapata G. Single-center experience with endovascular treatment of cerebral arteriovenous malformations with intent to cure in pediatric patients. Childs Nerv Syst 2022; 38:343-351. [PMID: 34605999 DOI: 10.1007/s00381-021-05376-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2021] [Accepted: 08/01/2021] [Indexed: 11/24/2022]
Abstract
PURPOSE This study aimed to report the incidence of technical complications and immediate complete angiographic occlusion, identify associated factors with failure of complete occlusion and identify predictors of technical complications in a single-center experience of pediatric arteriovenous malformations (AVM) treated with endovascular treatment with intent to cure. METHODS Patients between 1 and 18 years of age undergoing endovascular embolization between 2011 and 2020 were included. RESULTS A total of 120 embolizations were performed in 69 patients. The most frequent clinical presentation was intracerebral hemorrhage (76.8%). Immediate obliteration of the malformations was achieved in 40 (58%) cases. The technical complication rate was 15%. AVM nidus size between 3 and 6 cm (OR: 3.91; 95% CI 1.1-13.85; p = 0.035) and the presence of multiple feeders (OR: 5.08; 95% CI 1.41-18.28; p = 0.074) were predictive of failure of immediate complete occlusion. The location of the temporal lobe (OR: 7.83; p = 0.048), deep venous drainage (OR: 4.67; p = 0.112), and the presence of an intranidal aneurysm (OR: 3.58; p = 0.134) were predictors of technical complications. CONCLUSIONS Embolization of pediatric AVMs with intent to cure shows a high rate of technical complications and acceptable immediate occlusion rates. Nidus size and the presence of multiple feeders were predictive of failure of complete occlusion, while temporal lobe location, deep venous drainage, and the presence of an intranidal aneurysm were predictors of technical complications. Further studies are needed to determine the best therapeutic approach in the pediatric population.
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Affiliation(s)
- Aaron Rodriguez-Calienes
- Grupo Estudiantil de Investigación en Neurociencias, Sociedad Científica de Estudiantes de Medicina de la Universidad de San Martín de Porres, Lima, Peru.,Facultad de Medicina Humana, Universidad de San Martín de Porres, Alameda del Corregidor 1531, La Molina 15024, Lima, Peru
| | - Diego Bustamante-Paytan
- Grupo Estudiantil de Investigación en Neurociencias, Sociedad Científica de Estudiantes de Medicina de la Universidad de San Martín de Porres, Lima, Peru. .,Facultad de Medicina Humana, Universidad de San Martín de Porres, Alameda del Corregidor 1531, La Molina 15024, Lima, Peru.
| | - Kiara Camacho-Caballero
- Facultad de Medicina Humana, Universidad Científica del Sur, Lima, Peru.,CHANGE, Research Working Group, Carrera de Medicina Humana, Universidad Cientifica del Sur, Lima, Peru
| | - Angie Mayoria-Vargas
- Grupo Estudiantil de Investigación en Neurociencias, Sociedad Científica de Estudiantes de Medicina de la Universidad de San Martín de Porres, Lima, Peru.,Facultad de Medicina Humana, Universidad de San Martín de Porres, Alameda del Corregidor 1531, La Molina 15024, Lima, Peru
| | - Rodolfo Rodríguez-Varela
- Department of Neurosurgery, Endovascular Neurosurgery Service, Hospital Nacional Guillermo Almenara Irigoyen, Lima, Peru
| | - Giancarlo Saal-Zapata
- Department of Neurosurgery, Endovascular Neurosurgery Service, Hospital Nacional Guillermo Almenara Irigoyen, Lima, Peru
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11
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Brevis Nuñez F, Dohna-Schwake C. Epidemiology, Diagnostics, and Management of Vein of Galen Malformation. Pediatr Neurol 2021; 119:50-55. [PMID: 33895584 DOI: 10.1016/j.pediatrneurol.2021.02.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/25/2020] [Revised: 02/16/2021] [Accepted: 02/22/2021] [Indexed: 10/22/2022]
Abstract
BACKGROUND Vein of Galen malformation (VGM) is a rare congenital intracerebral vascular malformation. The aim of this study was to gain reliable data about epidemiology; clinical manifestations; and pre-, peri- and postinterventional treatment strategies in Germany. METHODS This prospective epidemiologic study was conducted by Erhebungseinheit für Seltene Pädiatrische Erkrankungen in Deutschland, a hospital-based German nationwide surveillance unit for rare pediatric diseases. Patients aged upto 18 years with a new diagnosis of VGM were prospectively included between January 1, 2014 and December 31, 2015. RESULTS In the two-year study period, 30 individuals with newly diagnosed VGM were identified, resulting in an estimated annual incidence rate of VGM in Germany of at least 1: 58,100 live births. The main symptoms were age dependent. Neonates presented with mainly cardiac manifestations of high output failure; infants and older children mainly suffered from neurological complications. Of the patients with endovascular treatment 95% survived, but only 41% of these patients were discharged home without any complications. The Bicêtre Neonatal Evaluation Score was a good predictor for poor outcome but could have led to palliative care in some patients with good outcome. CONCLUSIONS The incidence of VGM in Germany is estimated to be 1:58,100 live births. The majority of patients were eligible for endovascular treatment. Nevertheless, due to side effects and long-term sequelae in the majority of patients, further improvement in care of children with VGM is needed.
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Affiliation(s)
- Francisco Brevis Nuñez
- Department of Neonatology & Pediatric Intensive Care, Sana-Kliniken Duisburg GmbH, Duisburg, Germany.
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12
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Rodriguez-Calienes A, Bustamante-Paytan D, Camacho K, Mayoria-Vargas A, Saal-Zapata G, Rodriguez-Varela R. Early Outcomes and Complications of Endovascular Treatment of Cerebral Arteriovenous Malformations in Pediatric Patients. Pediatr Neurosurg 2021; 56:116-124. [PMID: 33601400 DOI: 10.1159/000513577] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/03/2020] [Accepted: 12/03/2020] [Indexed: 11/19/2022]
Abstract
INTRODUCTION Arteriovenous malformations (AVMs) are the commonest cause of hemorrhagic stroke in children. Endovascular embolization is a feasible treatment modality, but cure rates are heterogenous from one series to another. We aimed to describe the immediate obliteration rates and periprocedural complications of embolization of pediatric AVMs. METHODS Between 2011 and 2019, participants below 18 years of age with AVMs treated by the same neurosurgeon at a single center were included. The clinical features, immediate angiographic results, and periprocedural complications were retrospectively collected from the clinical records. RESULTS Thirty-four embolization sessions were performed on 20 children (12 females with a mean age of 13). Intracranial hemorrhage was the most common presentation (75%), and the majority were frontal (30%) and basal ganglia (30%) lesions. An immediate complete angiographic obliteration was achieved in 9 patients (45%) with low-grade lesions (Spetzler-Martin grade I and II). NBCA was the most common embolic agent used (52.9%). Complications were reported in 3 (8.8%) out of 34 sessions. Two of them were intraoperative perforations with clinical consequences. A slight cortical hemorrhage during the procedure was observed in 1 patient without clinical repercussions. DISCUSSION This single-surgeon single-center experience suggests that endovascular treatment is a safe and efficient treatment for pediatric AVMs. Pediatric prognostic scores for a suitable selection of candidates are needed. Further studies are required to validate these results.
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Affiliation(s)
- Aaron Rodriguez-Calienes
- Grupo Estudiantil de Investigación en Neurociencias, Sociedad de Estudiantes de Medicina de la Universidad de San Martín de Porres, Lima, Peru, .,Facultad de Medicina Humana, Universidad de San Martín de Porres, Lima, Peru,
| | - Diego Bustamante-Paytan
- Grupo Estudiantil de Investigación en Neurociencias, Sociedad de Estudiantes de Medicina de la Universidad de San Martín de Porres, Lima, Peru.,Facultad de Medicina Humana, Universidad de San Martín de Porres, Lima, Peru
| | - Kiara Camacho
- Facultad de Medicina Humana, Universidad Científica del Sur, Lima, Peru
| | - Angie Mayoria-Vargas
- Grupo Estudiantil de Investigación en Neurociencias, Sociedad de Estudiantes de Medicina de la Universidad de San Martín de Porres, Lima, Peru.,Facultad de Medicina Humana, Universidad de San Martín de Porres, Lima, Peru
| | - Giancarlo Saal-Zapata
- Departamento de Neurocirugía, Servicio de Neurocirugía Endovascular, Hospital Nacional Guillermo Almenara Irigoyen, Lima, Peru
| | - Rodolfo Rodriguez-Varela
- Departamento de Neurocirugía, Servicio de Neurocirugía Endovascular, Hospital Nacional Guillermo Almenara Irigoyen, Lima, Peru
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13
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Medhi G, Gupta AK, Saini J, Ramalingaiah AH, Pendharkar H, Parida S. Pial arteriovenous fistula: A clinical and neuro-interventional experience of outcomes in a rare entity. Indian J Radiol Imaging 2020; 30:286-293. [PMID: 33273762 PMCID: PMC7694735 DOI: 10.4103/ijri.ijri_26_19] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2019] [Revised: 02/22/2019] [Accepted: 07/08/2020] [Indexed: 11/21/2022] Open
Abstract
Purpose: Pial arteriovenous fistulae (PAVF) are rare intracranial vascular malformations, predominantly seen in children and distinct from arteriovenous malformations and dural arteriovenous fistulae. PAVF often leads to high morbidity and mortality. The aim of our study was to describe the clinical features and endovascular management of PAVF at various intracranial locations; to analyze the use of liquid embolic agents and coils alone or in combination in the treatment of PAVF and to analyze the outcome of embolization. Materials and Methods: Retrospective review of diagnostic angiography and neurointerventional database of our institution identified a cohort of 15 patients with non-galenic PAVF from 2008 to 2014 out of 6750 patients. Fourteen patients were treated endovascularly with coils and liquid embolic materials in combination or alone. Patients were followed up for evaluation of prognosis. Results: Age of the patients ranged from 3 to 37 years. Most patients were male and most common presentation was headache followed by seizure. Most common location of fistula was frontal lobe. The most common type was single artery single hole fistula with venous varix. Satisfactory obliteration was seen in all cases. One patient developed intraparenchymal hematoma on the first post procedural day and outcome was poor. Conclusions: PAVF are rare intracranial vascular malformations which can effectively be managed endovascularly with liquid embolic, coils alone, or in combination. Complete occlusion of the fistula can be achieved in most cases in a single sitting with a reasonable morbidity related to the procedure, compared with the natural history of this disease.
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Affiliation(s)
- Gorky Medhi
- Department of Neuroimaging and Interventional Radiology, National Institute of Mental Health and Neurosciences, Bangalore, Karnataka, India.,Assistant Professor, Radiology (Interventional Radiology), Sikkim Manipal Institute of Medical Sciences, Gangtok, Sikkim, India
| | - Arun K Gupta
- Department of Neuroimaging and Interventional Radiology, National Institute of Mental Health and Neurosciences, Bangalore, Karnataka, India
| | - Jitender Saini
- Department of Neuroimaging and Interventional Radiology, National Institute of Mental Health and Neurosciences, Bangalore, Karnataka, India
| | - Arvinda H Ramalingaiah
- Department of Neuroimaging and Interventional Radiology, National Institute of Mental Health and Neurosciences, Bangalore, Karnataka, India
| | - Hima Pendharkar
- Department of Neuroimaging and Interventional Radiology, National Institute of Mental Health and Neurosciences, Bangalore, Karnataka, India
| | - Subhendu Parida
- Department of Neuroimaging and Interventional Radiology, National Institute of Mental Health and Neurosciences, Bangalore, Karnataka, India.,Care Hospital, Hyderabad, Telangana, India
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14
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Smajda S, Söderman M, Dorfmüller G, Dorison N, Nghe MC, Rodesch G. Endovascular management of torcular dural sinus malformations in children: the role of straight sinus occlusion. J Neurointerv Surg 2020; 13:278-283. [PMID: 33199540 DOI: 10.1136/neurintsurg-2020-016888] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2020] [Revised: 10/26/2020] [Accepted: 10/27/2020] [Indexed: 11/04/2022]
Abstract
BACKGROUND Torcular dural sinus malformations (tDSMs) with arteriovenous shunts are rare congenital intracranial vascular malformations that carry a high rate of neurologic impairment and death in the neonatal, infant and young pediatric population. Their impact on brain venous drainage, especially the deep venous system, is one of the key factors in the clinical prognosis and natural history of the disease. We describe our therapeutic strategy for tDSMs, disconnecting the reflux into the deep venous system by performing an endovascular straight sinus occlusion. METHODS Among all children with dural sinus malformations seen between 2002 and 2020, we retrospectively reviewed those with tDSM in whom straight sinus occlusion had been performed. RESULTS Our databank included nine patients with tDSM that were embolized. Mean age at the clinical onset was 8.9±9.6 months (min-max=0-31). Five patients presented a significant reflux in the straight sinus on digital subtraction angiography. Those patients were initially clinically worse (mean modified Rankin Scale (mRS) 3.8) than those who did not present with reflux (mean mRS 2.25), this reflux being responsible for intraventricular hemorrhage in three patients. The reflux was suppressed by transarterial embolization in one patient and by transvenous straight sinus occlusion in four patients. Staged endovascular treatment resulted in a complete cure in six patients without complications, and clinical improvement in all patients. CONCLUSION Straight sinus occlusion is a feasible technique that needs to be considered in the treatment strategy for tDSM with deep venous reflux in order to avoid or minimize brain damage.
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Affiliation(s)
- Stanislas Smajda
- Interventional Neuroradiology, The Fondation Adolphe de Rothschild Hospital, Paris, France
| | - Michael Söderman
- Neuroradiology, Karolinska Universitetssjukhuset, Stockholm, Sweden.,Karolinska Institutet Department of Clinical Neuroscience, Stockholm, Sweden
| | - Georg Dorfmüller
- Department of Pediatric Neurosurgery, The Fondation Adolphe de Rothschild Hospital, Paris, France
| | - Nathalie Dorison
- Department of Pediatric Neurosurgery, The Fondation Adolphe de Rothschild Hospital, Paris, France
| | - Marie-Claire Nghe
- Department of Anesthesiology and Intensive Care, The Fondation Adolphe de Rothschild Hospital, Paris, France
| | - Georges Rodesch
- Diagnostic and Interventional Neuroradiology Department, Hôpital Foch, Suresnes, France
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15
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Guerrero WR, Dandapat S, Ortega-Gutierrez S. Hemorrhagic Cerebrovascular Pathology in the Pediatric Population. Front Neurol 2020; 11:1055. [PMID: 33041990 PMCID: PMC7527474 DOI: 10.3389/fneur.2020.01055] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2020] [Accepted: 08/11/2020] [Indexed: 01/10/2023] Open
Abstract
Hemorrhagic cerebrovascular disease in the pediatric population can have devastating and long-term effects. Progress in the fields of genetics, neuroimaging, pharmacology, and surgical techniques has led to improved diagnosis and management of pediatric cerebrovascular diseases. In this review we discuss the current etiologies and medical and surgical treatments of hemorrhagic cerebrovascular pathology affecting infants and children. A special emphasis is placed on neuroendovascular treatment options. Increased knowledge about this unique pathology and the medical and therapeutic options will empower practitioners to more quickly and accurately identify and accurately treat hemorrhagic diseases in the pediatric population.
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Affiliation(s)
- Waldo R Guerrero
- Department of Neurosurgery, University of South Florida Morsani College of Medicine, Tampa, FL, United States
| | - Sudeepta Dandapat
- Department of Neurology, Radiology, and Neurosurgery, University of Iowa Carver College of Medicine, Comprehensive Stroke Center, Iowa City, IA, United States
| | - Santiago Ortega-Gutierrez
- Department of Neurology, Radiology, and Neurosurgery, University of Iowa Carver College of Medicine, Comprehensive Stroke Center, Iowa City, IA, United States
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16
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Shchehlov DV, Konotopchyk SV, Svyrydiuk OE, Bortnik IM, Momonova MY, Vyval MB. Endovascular Treatment of Intracranial Pial-Dural Arteriovenous Fistula: A Case Report. Surg J (N Y) 2020; 6:e118-e124. [PMID: 32566749 PMCID: PMC7297641 DOI: 10.1055/s-0040-1712533] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2019] [Accepted: 03/24/2020] [Indexed: 10/30/2022] Open
Abstract
Intracranial pial arteriovenous fistula (PAVF) is a rare cerebrovascular pathology characterized by abnormal direct high-flow connection between the pial or cortical feeding artery and draining vein. Dural arteriovenous fistula (DAVF) is a pathological shunt between the meningeal arteries and dural sinuses or meningeal veins. In case of association between PAVF and DAVF, diagnosis and treatment are more challenging. The high-flow arteriovenous shunt and deep venous drainage make PAVF more preferable for endovascular treatment; however, their embolization during single-session procedures can lead to extensive thrombosis of the draining veins and unfavorable outcomes. We present a case report of endovascular embolization of an intracranial PAVF-DAVF in a 2.5-year-old child. At the time of admission, the patient had hydrocephalus, mental retardation, pyramidal insufficiency, and seizures. Occlusion of the fistula was performed during two stages of embolization to reduce the risk of severe venous stasis and venous thrombosis. Guglielmi detachable coils (GDCs) and a liquid embolic agent (Histoacryl with Lipiodol) were used for embolization. The patient recovered well after the procedure, with significant mental improvement. This suggests that the deployment of GDCs in the afferent artery near a fistula before embolization with a liquid embolic agent can minimize the risk of uncontrolled penetration of the embolization into the draining veins and dural sinus. A multisession procedure can be an effective and reasonable method of PAVF and DAVF occlusion among existing treatment options.
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Affiliation(s)
- D V Shchehlov
- Department of Endovascular Neuroradiology, State Organization "Scientific - Practical Center of Endovascular Neuroradiology NAMS of Ukraine," Kyiv, Ukraine
| | - S V Konotopchyk
- Department of Endovascular Neuroradiology, State Organization "Scientific - Practical Center of Endovascular Neuroradiology NAMS of Ukraine," Kyiv, Ukraine
| | - O E Svyrydiuk
- Department of Endovascular Neuroradiology, State Organization "Scientific - Practical Center of Endovascular Neuroradiology NAMS of Ukraine," Kyiv, Ukraine
| | - I M Bortnik
- Department of Endovascular Neuroradiology, State Organization "Scientific - Practical Center of Endovascular Neuroradiology NAMS of Ukraine," Kyiv, Ukraine
| | - M Y Momonova
- Department of Endovascular Neuroradiology, State Organization "Scientific - Practical Center of Endovascular Neuroradiology NAMS of Ukraine," Kyiv, Ukraine
| | - M B Vyval
- Department of Endovascular Neuroradiology, State Organization "Scientific - Practical Center of Endovascular Neuroradiology NAMS of Ukraine," Kyiv, Ukraine
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17
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Eliava SS, Pilipenko YV, Yakovlev SB, Golanov AV, Maryashev SA, Grebenev FV. [Arteriovenous malformations of the brain in children: treatment results for 376 patients]. ZHURNAL VOPROSY NEĬROKHIRURGII IMENI N. N. BURDENKO 2020; 84:22-34. [PMID: 32412191 DOI: 10.17116/neiro20208402122] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
undefined Cerebral arteriovenous malformations (AVM) are increasingly detected in children. Objective To estimate the risk of hemorrhage in children with AVM before and after treatment and evaluate the outcomes of various methods of AVM management in children. Material and methods This study included 376 patients with various cerebral AVM under the age of 18 years. There were 273 patients with intracranial hemorrhage (72.6%). Results Recurrent hemorrhages within the first month were registered in 1.1% of patients with angiomatous AVM prior to treatment and in 15.4% of patients with fistulous AVM. Microsurgical resection of AVM was performed in 135 (35.9%) patients. Total resection was achieved in 97.8% of cases. There were no mortality after microsurgical procedures. Endovascular treatment was applied in 79 (21%) patients. Total embolization was achieved in 29.1% of patients. One patient (1.3%) died after endovascular procedure. Radiosurgery was performed in 140 (37.2%) patients with total obliteration after a single fraction in 64.4% of patients. Favorable long-term outcomes (GOS grades V-IV) were achieved in 89.6% of patients with available follow-up data (n=182). Recurrent hemorrhages were registered in 6% of patients (3.3% after radiosurgery, 2.7% after endovascular treatment). One patient with recurrent hemorrhage died after radiosurgery. Conclusion Early relapses of hemorrhage are not characteristic for children with cerebral AVM. Therefore, there are no indications for urgent surgery except for cases of intracerebral hematoma. In children, microsurgical treatment is preferred for angiomatous AVM, endovascular treatment - for fistulous AVM. Radiosurgery also ensures favorable outcomes. However, it is unreasonable to postpone AVM radiosurgical treatment in children with increased risk of recurrent hemorrhage considering relatively long period of post-radiation obliteration of AVM.
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Affiliation(s)
| | | | | | - A V Golanov
- Burdenko Neurosurgical Center, Moscow, Russia
| | | | - F V Grebenev
- I.M. Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russia
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18
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Lv X, Jiang C, Wang J. Pediatric intracranial arteriovenous shunts: Advances in diagnosis and treatment. Eur J Paediatr Neurol 2020; 25:29-39. [PMID: 31996298 DOI: 10.1016/j.ejpn.2019.12.025] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/27/2019] [Revised: 11/24/2019] [Accepted: 12/29/2019] [Indexed: 02/07/2023]
Abstract
Pediatric intracranial arteriovenous shunts (IAVSs) comprise a wide range of lesions, including pial arteriovenous malformation (AVM) and arteriovenous fistula (AVF), dural arteriovenous fistula (DAVF) and vein of Galen aneurysmal malformation (VGAM). We provide an overview of pediatric IAVSs, encompassing both diagnosis and endovascular treatment. We include references from pertinent literature and representative cases from our hospital. Pediatric IAVS are frequently associated two broader conditions, such as capillary malformation-arteriovenous malformation (CM-AVM) and hereditary hemorrhagic telangiectasia (HHT). These conditions and the associated genetic mutations have only recently been described. Their impact on the brain will be different in the prenatal period, in neonates, in infants, and in children, with variable symptoms according to each age group and the current strategies of endovascular treatment in the management of these vascular lesions will be discussed. This review could improve the understanding of pediatric IAVSs and their diagnosis and treatment.
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Affiliation(s)
- Xianli Lv
- Neurosurgery Department, Beijing Tsinghua Changgung Hospital, School of Clinical Medicine, Tsinghua University, Beijing, China.
| | - Chuhan Jiang
- Neurosurgery Department, Beijing Tsinghua Changgung Hospital, School of Clinical Medicine, Tsinghua University, Beijing, China
| | - James Wang
- Neurosurgery Department, Beijing Tsinghua Changgung Hospital, School of Clinical Medicine, Tsinghua University, Beijing, China
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19
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Zaki Ghali MG, Kan P, Britz GW. Curative Embolization of Arteriovenous Malformations. World Neurosurg 2019; 129:467-486. [DOI: 10.1016/j.wneu.2019.01.166] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2018] [Revised: 01/15/2019] [Accepted: 01/17/2019] [Indexed: 10/27/2022]
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20
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Meling TR, Patet G. What is the best therapeutic approach to a pediatric patient with a deep-seated brain AVM? Neurosurg Rev 2019; 42:409-416. [PMID: 30980204 DOI: 10.1007/s10143-019-01101-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2019] [Accepted: 03/27/2019] [Indexed: 11/25/2022]
Abstract
Although brain arteriovenous malformations (bAVMs) account for a very small proportion of cerebral pathologies in the pediatric population, they are the cause of roughly 50% of spontaneous intracranial hemorrhages. Pediatric bAVMs tend to rupture more frequently and seem to have higher recurrence rates than bAVMs in adults. Thus, the management of pediatric bAVMs is particularly challenging. In general, the treatment options are conservative treatment, microsurgery, endovascular therapy (EVT), gamma knife radiosurgery (GKRS), proton-beam stereotactic radiosurgery (PSRS), or a combination of the above. In order to identify the best approach to deep-seated pediatric bAVMs, we performed a systematic review, according to the PRISMA guidelines. None of the options seem to offer a clear advantage over the others when used alone. Microsurgery provides the highest obliteration rate, but has higher incidence of neurological complications. EVT may play a role when used as adjuvant therapy, but as a stand-alone therapy, the efficacy is low and the long-term side effects of radiation from the multiple sessions required in deep-seated pediatric bAVMs are still unknown. GKRS has a low risk of complication, but the obliteration rates still leave much to be desired. Finally, PSRS offers promising results with a more accurate radiation that avoids the surrounding tissue, but data is limited due to its recent introduction. Overall, a multi-modal approach, or even an active surveillance, might be the most suitable when facing deep-seated bAVM, considering the difficulty of their management and the high risk of complications in the pediatric population.
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Affiliation(s)
- Torstein R Meling
- Department of Clinical Neurosciences, Division of Neurosurgery, Geneva University Hospitals, Geneva, Switzerland.
- Faculty of Medicine, University of Geneva, Geneva, Switzerland.
- Faculty of Medicine, University of Oslo, Oslo, Norway.
- Department of Neurosurgery, Oslo University Hospital, Oslo, Norway.
| | - Gildas Patet
- Department of Clinical Neurosciences, Division of Neurosurgery, Geneva University Hospitals, Geneva, Switzerland
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21
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Management of Stroke in Neonates and Children: A Scientific Statement From the American Heart Association/American Stroke Association. Stroke 2019; 50:e51-e96. [DOI: 10.1161/str.0000000000000183] [Citation(s) in RCA: 240] [Impact Index Per Article: 48.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
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22
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Al-Smadi AS, Ansari SA, Shokuhfar T, Malani A, Sattar S, Hurley MC, Potts MB, Jahromi BS, Alden TD, Dipatri AJ, Shaibani A. Safety and outcome of combined endovascular and surgical management of low grade cerebral arteriovenous malformations in children compared to surgery alone. Eur J Radiol 2019; 116:8-13. [PMID: 31153578 DOI: 10.1016/j.ejrad.2019.02.016] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2018] [Revised: 01/17/2019] [Accepted: 02/13/2019] [Indexed: 10/27/2022]
Abstract
PURPOSE To evaluate the outcomes of combined preoperative embolization and microsurgical resection in comparison with microsurgical resection alone as the current standard of care for low-grade cerebral arteriovenous malformations (AVM) in the pediatric population. MATERIALS & METHODS We performed a single-center retrospective study of pediatric patients presenting with Spetzler-Martin (SM) grade I and II cerebral AVMs at a high-volume tertiary pediatric hospital between January 2005 and September 2016. Low grade AVM patients were divided into two groups: pre-operative embolization with subsequent microsurgical resection or microsurgical resection alone. Patient demographics, clinical and imaging presentations, AVM morphological characteristics, post-operative complications, and mid to long-term clinical outcomes were studied. Post-embolization and post-surgical outcomes were assessed prior to and after treatment, at 3 months and at final follow-up using the modified Rankin Scale (mRS) to compare both final independent (mRS 0-2) and favorable (no change or improved mRS) clinical outcomes for comparison between study groups. Statistical associations of patient demographics, AVM characteristics/SM grading, and treatment modality group with post-operative complications were performed using univariate logistic regression analysis. RESULTS Thirty-four patients with low grade cerebral AVMs met the study inclusion criteria (mean age 10.6 ± 3.4 years; range 3-16 years, 22M:12 F). Twenty patients (59%) presented with ruptured AVMs. Twenty-five patients (73.5%) underwent combined treatment with embolization and microsurgical resection, while 9/34 (26.5%) underwent microsurgical resection alone. A total of 35 embolization procedures performed in 25 patients (Mode, 1; Range, 1-7) were associated with two minor post-embolization and 7 subsequent post-surgical (28%) complications, resulting in clinical deterioration in a single patient. Microsurgical resection alone was associated with 3 post-surgical complications (33%), resulting in permanent neurological disability in a single patient. There was no significance association of post-operative complications with either treatment modality group, combined treatment versus surgical resection alone [OR:1.13; 95% CI:0.23-5.62; p-value 0.88]. SM Grade II and eloquent locations were found to be significantly associated with post-surgical complications of low grade pediatric cerebral AVMs [OR 13.2 and OR 8 respectively, p-value 0.004 and 0.005). On mean follow-up time of 35.7 months, final clinical outcome was favorable in the majority of both treatment arms with no dependent (mRS>2) patients in the combined endovascular and surgical cohort. Two patients in the surgical cohort failed to achieve independent functional status, primarily due to a pre-operative morbid status (p-value 0.015). However, there was no significant difference in favorable outcomes between the treatment groups [p-value 0.14]. CONCLUSION Our study suggests equivalent safety and favorable clinical outcomes related to combined endovascular embolization and microsurgical resection of low grade pediatric cerebral AVMs in comparison to microsurgical resection alone. On long term clinical follow-up, the vast majority of patients achieved an independent and favorable functional status irrespective of pre-operative embolization.
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Affiliation(s)
- Anas S Al-Smadi
- Department of Radiology, Northwestern University, Feinberg School of Medicine, Chicago, IL, United States
| | - Sameer A Ansari
- Department of Radiology, Northwestern University, Feinberg School of Medicine, Chicago, IL, United States; Department of Neurology, Northwestern University, Feinberg School of Medicine, Chicago, IL, United States; Department of Neurological Surgery, Northwestern University, Feinberg School of Medicine, Chicago, IL, United States
| | - Tahaamin Shokuhfar
- Department of Radiology, Northwestern University, Feinberg School of Medicine, Chicago, IL, United States
| | - Aresha Malani
- Department of Radiology, Northwestern University, Feinberg School of Medicine, Chicago, IL, United States
| | - Saadia Sattar
- Department of Radiology, Northwestern University, Feinberg School of Medicine, Chicago, IL, United States
| | - Michael C Hurley
- Department of Radiology, Northwestern University, Feinberg School of Medicine, Chicago, IL, United States; Department of Neurological Surgery, Northwestern University, Feinberg School of Medicine, Chicago, IL, United States
| | - Matthew B Potts
- Department of Radiology, Northwestern University, Feinberg School of Medicine, Chicago, IL, United States; Department of Neurological Surgery, Northwestern University, Feinberg School of Medicine, Chicago, IL, United States
| | - Babak S Jahromi
- Department of Radiology, Northwestern University, Feinberg School of Medicine, Chicago, IL, United States; Department of Neurological Surgery, Northwestern University, Feinberg School of Medicine, Chicago, IL, United States
| | - Tord D Alden
- Department of Neurological Surgery, Northwestern University, Feinberg School of Medicine, Chicago, IL, United States
| | - Arthur J Dipatri
- Department of Neurological Surgery, Northwestern University, Feinberg School of Medicine, Chicago, IL, United States
| | - Ali Shaibani
- Department of Radiology, Northwestern University, Feinberg School of Medicine, Chicago, IL, United States; Department of Neurological Surgery, Northwestern University, Feinberg School of Medicine, Chicago, IL, United States.
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23
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Furtado SV, Berenstein A. Distal microcatheter placement using the Asahi Chikai TM 0.008-inch micro-guidewire for liquid embolic material delivery: A technical note. World Neurosurg 2019; 124:36-43. [PMID: 30615991 DOI: 10.1016/j.wneu.2018.12.132] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2018] [Revised: 12/13/2018] [Accepted: 12/14/2018] [Indexed: 10/27/2022]
Abstract
INTRODUCTION Management of vascular malformations requires microcatheter manipulation through distal tortuous arterial feeders less than a millimetre in diameter, to permit safe and effective embolization at the fistula or nidus location. The Asahi ChikaiTM 0.008 inch micro-guidewire recently introduced in the United States was used to evaluate microcatheter torque, support and safety in distal microcatheter navigation. METHODS The use of the Asahi Chikai 0.008 inch micro-guidewire in conjunction with flow-guided, and over the wire microcatheters was evaluated in 25 neuroendovascular cases over a 1 year period. It involved single operator usage for endovascular microcatheter embolization of intracranial vascular malformations listed below. The study evaluated angiographic evidence of distal microcatheter positioning, subsequent obliteration of the fistula at the location and complications if any. RESULTS The micro-guidewire was used in microcatheter embolization of 10 vein of Galen malformations, 11 brain and head & neck arteriovenous malformations, 2 spinal and 2 cranial dural arteriovenous fistula. Good flow directed and over the wire microcatheter placement using the Asahi ChikaiTM 0.008 inch micro-guidewire was possible across the spectrum of cases achieving optimum catheterization and safe embolization in all. There were no micro-guidewire or microcatheter related vessel spasm, dissection, or perforation during their combined or individual manipulation, contrast or embolic extravasation on fluoroscopy or post- embolization angiograms CONCLUSION: The Asahi ChikaiTM 0.008 inch micro-guidewire is a safe, sturdy micro-guidewire which provides good torque in distal arterial anatomy while providing microcatheter support and maintaining tip configuration on repeated use.
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Affiliation(s)
- Sunil V Furtado
- Department of Neurosurgery, Ramaiah Medical College and Hospital, Bangalore, India.
| | - Alejandro Berenstein
- Department of Neurosurgery, Icahn School of Medicine ,Mount Sinai Health Care System, New York, New York,USA
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24
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Hockley A, Tso MK, Almekhlafi MA, Lodha AK, Clegg R, Luntley J, Eesa M, Wong JH. Rapid cardiac ventricular pacing to facilitate embolization of vein of Galen malformations: technical note. J Neurosurg Pediatr 2019; 23:86-91. [PMID: 30485233 DOI: 10.3171/2018.7.peds1852] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2018] [Accepted: 07/10/2018] [Indexed: 11/06/2022]
Abstract
In BriefBabies born with life-threatening brain blood-vessel malformations can be helped with new heart pacemaker technology to temporarily stop the flow of blood in their bodies during surgery, for inducing hypotension to aid in controlled embolization.
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Affiliation(s)
- Aaron Hockley
- 1Division of Neurosurgery, Department of Clinical Neurosciences, University of Calgary
| | - Michael K Tso
- 1Division of Neurosurgery, Department of Clinical Neurosciences, University of Calgary
| | | | - Abhay K Lodha
- 3Division of Neonatology, Department of Paediatrics, University of Calgary
| | - Robin Clegg
- 4Division of Pediatric Cardiology, Department of Pediatrics and Libin Cardiovascular Institute of Alberta, University of Calgary
| | - Jeremy Luntley
- 5Division of Pediatric Anesthesia, Department of Anesthesia, and Division of Critical Care, Department of Pediatrics, University of Calgary; and
| | - Muneer Eesa
- 6Department of Radiology, University of Calgary, Alberta, Canada
| | - John H Wong
- 1Division of Neurosurgery, Department of Clinical Neurosciences, University of Calgary
- 6Department of Radiology, University of Calgary, Alberta, Canada
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25
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Goyal P, Mangla R, Gupta S, Malhotra A, Almast J, Sapire J, Kolar B. Pediatric Congenital Cerebrovascular Anomalies. J Neuroimaging 2018; 29:165-181. [DOI: 10.1111/jon.12575] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2018] [Revised: 10/11/2018] [Accepted: 10/13/2018] [Indexed: 11/29/2022] Open
Affiliation(s)
- Pradeep Goyal
- Department of Radiology; St. Vincent's Medical Center; Bridgeport CT
| | - Rajiv Mangla
- Department of Radiology; SUNY Upstate Medical University; Syracuse NY
| | - Sonali Gupta
- Department of Medicine; St. Vincent's Medical Center; Bridgeport CT
| | - Ajay Malhotra
- Department of Radiology and Biomedical Imaging; Yale School of Medicine; New Haven CT
| | - Jeevak Almast
- Department of Radiology; University of Rochester Medical Center; Rochester NY
| | - Joshua Sapire
- Department of Radiology; St. Vincent's Medical Center; Bridgeport CT
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26
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Hatayama K, Goto S, Nishida A, Inoue M. Pial arteriovenous fistula of the spine in a child with hemiplegia. Clin Case Rep 2018; 6:1132-1136. [PMID: 29881582 PMCID: PMC5986038 DOI: 10.1002/ccr3.1557] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2018] [Revised: 03/14/2018] [Accepted: 04/06/2018] [Indexed: 11/22/2022] Open
Abstract
Pial arteriovenous fistula (AVF) is an extremely rare disease in children. When a child presents with sudden onset of hemiparesis and headache, it is very important to perform spinal magnetic resonance imaging (MRI) scanning for early diagnosis and treatment.
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Affiliation(s)
- Kazuki Hatayama
- Department of PediatricsOkayama Red‐Cross HospitalOkayamaJapan
| | - Shinichiro Goto
- Department of PediatricsOkayama Red‐Cross HospitalOkayamaJapan
| | - Ayumi Nishida
- Department of Neuroendovascular TherapyOkayama Red‐Cross HospitalOkayamaJapan
| | - Masaru Inoue
- Department of PediatricsOkayama Red‐Cross HospitalOkayamaJapan
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27
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Clipping of a Pediatric Pial Arteriovenous Fistula Located at Basilar Artery Tip Using a Hybrid Trapping-Evacuation Technique. World Neurosurg 2018; 117:292-297. [PMID: 29803571 DOI: 10.1016/j.wneu.2018.05.110] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2018] [Revised: 05/15/2018] [Accepted: 05/16/2018] [Indexed: 11/21/2022]
Abstract
BACKGROUND Intracranial pial arteriovenous fistulas (PAVFs) are rare cerebrovascular lesions with high mortality rates. We report a rare case of pediatric PAVF at the basilar artery tip and its treatment with surgical clipping aided by a trapping-evacuation technique in a hybrid operating room. CASE DESCRIPTION An 18-month-old boy was admitted with hypoevolutism and 4-month history of weakness in the left extremities. Magnetic resonance imaging showed a giant aneurysm-like malformation in the area of midbrain and pons. Angiography showed a high-flow PAVF fed by the basilar artery and bilateral P1 segments of the posterior cerebral artery, with deep draining veins into the transverse sinus and straight sinus. Given the intrinsic characteristics of the lesion, such as deep location, giant fistula and varix, and multiple feeding arteries, clipping of PAVF was performed in a hybrid operating room aided by a trapping-evacuation technique to clearly identify and block the shunting point. CONCLUSIONS The successful obliteration of the lesion is reported. In addition, a brief review of literature comparing endovascular embolization, surgical disconnection, and hybrid technique for treatment of PAVF is included.
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28
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Mahmoud M, Abdalla RN, Mohamed AH, Farid M. Pial fistula in infancy: Report of two cases and literature review with special emphasis on the ruptured group. Interv Neuroradiol 2018; 24:444-449. [PMID: 29562860 DOI: 10.1177/1591019918763146] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Cerebral pial fistula is a rare vascular pathology with no more than 150 cases reported. Most cases reported in infancy have been published as case reports. Owing to its high flow, its occurrence in this age group carries the potential risk of heart failure, chronic venous hypertension, seizures and, less frequently, cerebral haemorrhage. We present two cases of pial fistulae in infancy treated by endovascular embolisation using N-butyl cyanoacrylate. A review of the English-language literature was performed for this age group with special emphasis on ruptured cases.
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Affiliation(s)
- Mostafa Mahmoud
- 1 Ain Shams University, Interventional Neuroradiology Unit/Radiology Department, Cairo, Egypt.,2 Dr Soliman Fakeeh Hospital, Interventional Neuroradiology Unit/Radiology Department, Jeddah, Makkah, Saudi Arabia
| | - Ramez Nader Abdalla
- 3 Ain Shams University, Interventional Neuroradiology Unit/Radiology Department, Cairo, Egypt
| | - Ayman Hemdan Mohamed
- 4 Dr Soliman Fakeeh Hospital, Pediatrics Department, Jeddah, Mecca, Saudi Arabia
| | - Mostafa Farid
- 3 Ain Shams University, Interventional Neuroradiology Unit/Radiology Department, Cairo, Egypt
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29
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Goel A, Jain S, Shah A, Rai S, Gore S, Dharurkar P. Pial Arteriovenous Fistula: A Brief Review and Report of 14 Surgically Treated Cases. World Neurosurg 2018; 110:e873-e881. [DOI: 10.1016/j.wneu.2017.11.121] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2017] [Revised: 11/21/2017] [Accepted: 11/22/2017] [Indexed: 10/18/2022]
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30
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Brinjikji W, Krings T, Murad MH, Rouchaud A, Meila D. Endovascular Treatment of Vein of Galen Malformations: A Systematic Review and Meta-Analysis. AJNR Am J Neuroradiol 2017; 38:2308-2314. [PMID: 28982789 DOI: 10.3174/ajnr.a5403] [Citation(s) in RCA: 38] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2017] [Accepted: 08/07/2017] [Indexed: 01/31/2023]
Abstract
BACKGROUND Outcomes after endovascular embolization of vein of Galen malformations remain relatively poorly described. PURPOSE We performed a systematic review of the literature to determine outcomes and predictors of good outcomes following endovascular treatment of vein of Galen malformations. DATA SOURCES We used Ovid MEDLINE, Ovid Embase, and the Web of Science. STUDY SELECTION Our study consisted of all case series with ≥4 patients receiving endovascular treatment of vein of Galen malformations published through January 2017. DATA ANALYSIS We studied the following outcomes: complete/near-complete occlusion rates, technical complications, perioperative stroke, perioperative hemorrhage, technical mortality, all-cause mortality, poor neurologic outcomes, and good neurologic outcomes. Outcomes were stratified by age-group (neonate, infant, child). A random-effects meta-analysis was performed. DATA SYNTHESIS A total of 27 series with 578 patients were included; 41.9% of patients were neonates, 45.0% of patients were infants, and 13.1% of patients were children. All-cause mortality was 14.0% (95% CI, 8.0%-22.0%). Overall good neurologic outcome rates were 62.0% (95% CI, 57.0%-67.0%). Overall poor neurologic outcome rates were 21.0% (95% CI, 17.0%-26.0%). Neonates were significantly less likely to have good neurologic outcomes than infants (48.0%; 95% CI, 35.0%-62.0% versus 77.0%; 95% CI, 70.0%-84.0%; P < .01). Treatment indications following the Bicêtre neonatal evaluation score resulted in significantly higher rates of good neurologic outcome (P = .04). Patients with congestive heart failure had significantly lower rates of good neurologic outcome (OR, 0.50; 95% CI, 0.28-0.88; P = .01). LIMITATIONS Limitations were selection and publication biases. CONCLUSIONS Patients receiving endovascular embolization of vein of Galen malformations experienced good long-term clinical outcomes in >60% of cases. Appropriate patient selection is key as treatment guided by the Bicêtre neonatal evaluation score was associated with improved neurologic outcomes.
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Affiliation(s)
- W Brinjikji
- From the Departments of Radiology (W.B.)
- Neurosurgery, (W.B.)
- Division of Neuroradiology and Neurosurgery (W.B., T.K.), University of Toronto, Toronto Western Hospital and University Health Network, Toronto, Ontario, Canada
| | - T Krings
- Division of Neuroradiology and Neurosurgery (W.B., T.K.), University of Toronto, Toronto Western Hospital and University Health Network, Toronto, Ontario, Canada
| | - M H Murad
- Center for the Science of Healthcare Delivery (M.H.M.), Mayo Clinic, Rochester, Minnesota
| | - A Rouchaud
- Neuroradiology Service (A.R.), Centre Hospitalier Universitaire Bicêtre, Le Kremlin Bicêtre, France
| | - D Meila
- Department of Radiology and Neuroradiology (D.M.), Klinikum Duisburg, Duisburg, Germany
- Department of Diagnostic and Interventional Neuroradiology (D.M.), Medical School Hannover, Hannover, Germany
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31
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Martínez-Payo C, Sancho Saúco J, Miralles M, Pérez Medina T. Nongalenic pial arteriovenous fistula: Prenatal diagnosis. JOURNAL OF CLINICAL ULTRASOUND : JCU 2017; 45:621-625. [PMID: 28369985 DOI: 10.1002/jcu.22478] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/22/2016] [Revised: 01/24/2017] [Accepted: 01/29/2017] [Indexed: 06/07/2023]
Abstract
Pial arteriovenous (AV) fistulae have rarely been diagnosed in utero. They are characterized by one or more pial arteries flowing directly into a cortical vein without any shunt or interposed capillary bed. In the fetus and the newborn up to 2 years of age, the most common clinical manifestation is heart failure resulting from fistula overload. Later on, hydrocephalus, focal neurologic deficits, headaches, seizures, and cerebral hemorrhage are the most common manifestations. We present a case of nongalenic pial AV fistula diagnosed in the 25th week of pregnancy, which resulted in intrauterine fetal death due to congestive heart failure. © 2017 Wiley Periodicals, Inc. J Clin Ultrasound 45:621-625, 2017.
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Affiliation(s)
- Cristina Martínez-Payo
- Servicio de Obstetricia y Ginecología, Unidad de Diagnóstico Prenatal, Hospital Universitario Puerta de Hierro Majadahonda, Calle Manuel de Falla n°1., 28222, Madrid, Spain
| | - Javier Sancho Saúco
- Servicio de Obstetricia y Ginecología, Unidad de Diagnóstico Prenatal, Hospital Universitario Puerta de Hierro Majadahonda, Calle Manuel de Falla n°1., 28222, Madrid, Spain
| | - Maria Miralles
- Servicio de Radiología, Unidad de Radiología Pediátrica, Hospital Universitario Puerta de Hierro Majadahonda, Madrid, Spain
| | - Tirso Pérez Medina
- Servicio de Obstetricia y Ginecología, Unidad de Diagnóstico Prenatal, Hospital Universitario Puerta de Hierro Majadahonda, Calle Manuel de Falla n°1., 28222, Madrid, Spain
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32
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Joo W, Mercier P, Kheradmand S, Shirani P, Sarhan A, Elbabaa SK, Edgell RC. Vein of Galen malformation treated with the Micro Vascular Plug system: case report. J Neurosurg Pediatr 2017; 19:729-733. [PMID: 28338447 DOI: 10.3171/2016.12.peds16305] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
This case report describes the use of the Micro Vascular Plug (MVP) system in a mural-type vein of Galen aneurysmal malformation, resulting in successful occlusion of the cerebrovascular fistula. This result was confirmed with immediate cessation in blood flow and 6-month follow-up angiography. The unique characteristics of the MVP provide potential advantages over current embolic techniques for occlusion of high-flow, fistulous, intracranial vessels such as those seen in the vein of Galen aneurysmal malformation, and may represent a valuable addition to the currently available options.
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Affiliation(s)
- Woojin Joo
- St. Louis University School of Medicine, St. Louis, Missouri; and
| | - Philippe Mercier
- St. Louis University School of Medicine, St. Louis, Missouri; and
| | - Shiva Kheradmand
- Midwestern University Arizona College of Osteopathic Medicine, Glendale, Arizona
| | - Peyman Shirani
- St. Louis University School of Medicine, St. Louis, Missouri; and
| | - Ahmed Sarhan
- St. Louis University School of Medicine, St. Louis, Missouri; and
| | - Samer K Elbabaa
- St. Louis University School of Medicine, St. Louis, Missouri; and
| | - Randall C Edgell
- St. Louis University School of Medicine, St. Louis, Missouri; and
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33
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Pedicelli A, Iacobucci M, Frassanito P, Lozupone E, Masselli G, Di Rocco C, Colosimo C. Prenatal Diagnosis and Multimodal Neonatal Treatment of a Rare Pial Arteriovenous Fistula: Case Report and Review of the Literature. World Neurosurg 2017; 104:1050.e13-1050.e18. [PMID: 28559076 DOI: 10.1016/j.wneu.2017.05.121] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2017] [Revised: 05/18/2017] [Accepted: 05/19/2017] [Indexed: 11/29/2022]
Abstract
BACKGROUND Intracranial pial arteriovenous fistulas (PAVFs) are direct communications between the arterial and venous system of the brain, with the characteristic absence of a plexiform nidus, as seen in the classic cerebral arteriovenous malformations. These vascular malformations, usually occurring in the pediatric population, very rarely are diagnosed in utero, because of a lack of understanding of the condition and because they may be hard to visualize. CASE DESCRIPTION We report a rare case of a mass-effect PAVF diagnosed with fetal magnetic resonance imaging, involving the right cerebral hemisphere, fed by a pericallosal artery and associated with a giant venous dilatation. The PAVF initially was managed by the endovascular embolization. The recruitment of a middle cerebral artery feeder and the rapidly enlarging size of the venous pouch with mass effect required subsequent surgery. CONCLUSIONS The 2-stage multimodal treatment resulted in complete disappearance of the PAVF without complications.
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Affiliation(s)
- Alessandro Pedicelli
- Department of Radiology, Catholic University of Sacred Heart, Fondazione Policlinico Universitario A. Gemelli, Rome, Italy
| | - Marta Iacobucci
- Department of Radiology, Catholic University of Sacred Heart, Fondazione Policlinico Universitario A. Gemelli, Rome, Italy.
| | - Paolo Frassanito
- Pediatric Neurosurgery, Catholic University of Sacred Heart, Fondazione Policlinico Universitario A. Gemelli, Rome, Italy
| | - Emilio Lozupone
- Department of Radiology, Catholic University of Sacred Heart, Fondazione Policlinico Universitario A. Gemelli, Rome, Italy
| | | | - Concezio Di Rocco
- Department of Neurosurgery, International Neuroscience Institute, Hannover, Germany
| | - Cesare Colosimo
- Department of Radiology, Catholic University of Sacred Heart, Fondazione Policlinico Universitario A. Gemelli, Rome, Italy
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34
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Morales-Gómez JA, Garza-Oyervides VV, Arenas-Ruiz JA, Mercado-Flores M, Elizondo-Riojas CG, Boop FA, de León ÁMP. Hydrocephalus in a patient with an unruptured pial arteriovenous fistula: hydrodynamic considerations, endovascular treatment, and clinical course. J Neurosurg Pediatr 2017; 19:307-311. [PMID: 28059677 DOI: 10.3171/2016.9.peds16458] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Intracranial pial arteriovenous fistulas, also known as nongalenic fistulas, are rare vascular malformations affecting predominantly the pediatric population. Hydrocephalus is an unusual presentation in which the exact pathophysiology is not fully understood. The aim of treatment in these cases is occlusion of the fistula prior to considering ventricular shunting. Here, the authors describe the hydrodynamic considerations of the paravascular pathway and the resolution of hydrocephalus with endovascular treatment of the fistula.
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Affiliation(s)
| | | | | | - Mariana Mercado-Flores
- Centro Universitario de Imagen Diagnóstica, Hospital Universitario "Dr. José Eleuterio González," Monterrey, Nuevo León, México; and
| | - C Guillermo Elizondo-Riojas
- Centro Universitario de Imagen Diagnóstica, Hospital Universitario "Dr. José Eleuterio González," Monterrey, Nuevo León, México; and
| | - Frederick A Boop
- Department of Neurosurgery, University of Tennessee Health Sciences Center, Memphis, Tennessee
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35
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Yu J, Lv X, Li Y, Wu Z. Therapeutic progress in pediatric intracranial dural arteriovenous shunts: A review. Interv Neuroradiol 2016; 22:548-56. [PMID: 27306522 PMCID: PMC5072209 DOI: 10.1177/1591019916653254] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2016] [Accepted: 04/22/2016] [Indexed: 02/05/2023] Open
Abstract
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.
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Affiliation(s)
- Jinlu Yu
- Department of Neurosurgery, First Hospital of Jilin University, Changchun, China
| | - Xianli Lv
- Department of Interventional Neuroradiology, Beijing Neurosurgical Institute, Capital Medical University, Beijing, China Beijing Tiantan Hospital, Beijing, China
| | - Youxiang Li
- Department of Interventional Neuroradiology, Beijing Neurosurgical Institute, Capital Medical University, Beijing, China Beijing Tiantan Hospital, Beijing, China
| | - Zhongxue Wu
- Department of Interventional Neuroradiology, Beijing Neurosurgical Institute, Capital Medical University, Beijing, China Beijing Tiantan Hospital, Beijing, China
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36
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El-Ghanem M, Kass-Hout T, Kass-Hout O, Alderazi YJ, Amuluru K, Al-Mufti F, Prestigiacomo CJ, Gandhi CD. Arteriovenous Malformations in the Pediatric Population: Review of the Existing Literature. INTERVENTIONAL NEUROLOGY 2016; 5:218-225. [PMID: 27781052 DOI: 10.1159/000447605] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Arteriovenous malformations (AVMs) in the pediatric population are relatively rare but reportedly carry a higher rate of rupture than in adults. This could be due to the fact that most pediatric AVMs are only detected after rupture. We aimed to review the current literature regarding the natural history and the clinical outcome after multimodality AVM treatment in the pediatric population, as optimal management for pediatric AVMs remains controversial. A multidisciplinary approach using multimodality therapy if needed has been proved to be beneficial in approaching these lesions in all age groups. Microsurgical resection remains the gold standard for the treatment of all accessible pediatric AVMs. Embolization and radiosurgery should be considered as an adjunctive therapy. Embolization provides a useful adjunct therapy to microsurgery by preventing significant blood loss and to radiosurgery by decreasing the volume of the AVM. Radiosurgery has been described to provide an alternative treatment approach in certain circumstances either as a primary or adjuvant therapy.
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Affiliation(s)
- Mohammad El-Ghanem
- Department of Neurology, Pennsylvania State University, Hershey, Pa, N.Y., USA
| | - Tareq Kass-Hout
- Department of Neurosurgery and Neuroscience, Rutgers University School of Medicine, Newark, N.J, N.Y., USA; Division of Neuro-Endovascular Surgery, Department of Surgery, Rochester Regional Health System, Rochester, N.Y., USA
| | - Omar Kass-Hout
- Department of Neurology, Emory University School of Medicine, Atlanta, Va, N.Y., USA
| | - Yazan J Alderazi
- Department of Neurosurgery and Neuroscience, Rutgers University School of Medicine, Newark, N.J, N.Y., USA
| | - Krishna Amuluru
- Department of Neurosurgery and Neuroscience, Rutgers University School of Medicine, Newark, N.J, N.Y., USA
| | - Fawaz Al-Mufti
- Department of Neurosurgery and Neuroscience, Rutgers University School of Medicine, Newark, N.J, N.Y., USA
| | - Charles J Prestigiacomo
- Department of Neurosurgery and Neuroscience, Rutgers University School of Medicine, Newark, N.J, N.Y., USA
| | - Chirag D Gandhi
- Department of Neurosurgery and Neuroscience, Rutgers University School of Medicine, Newark, N.J, N.Y., USA
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37
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Jagadeesan BD, Zacharatos H, Nascene DR, Grande AW, Guillaume DJ, Tummala RP. Endovascular management of a vein of Galen aneurysmal malformation in an infant with challenging femoral arterial access. J Neurosurg Pediatr 2016; 18:231-4. [PMID: 27058455 DOI: 10.3171/2016.2.peds15652] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
A 5-month-old infant was to be treated with elective transarterial embolization for a vein of Galen aneurysmal malformation (VGAM). A team of endovascular surgical neuroradiologists, pediatric interventional radiologists, and pediatric cardiologists attempted conventional femoral arterial access, which was unsuccessful given the small caliber of the femoral arteries and superimposed severe vasospasm. Thereafter, eventual arterial access was achieved by navigating from the venous to the arterial system across the patent foramen ovale following a right femoral venous access. Embolization was then successfully performed. At a later date, the child underwent successful transvenous balloon-assisted embolization and eventual arterial embolization with cure of the VGAM.
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Affiliation(s)
- Bharathi D Jagadeesan
- Departments of 1 Radiology.,Neurosurgery, and.,Neurology, University of Minnesota, Minneapolis, Minnesota
| | | | | | - Andrew W Grande
- Departments of 1 Radiology.,Neurosurgery, and.,Neurology, University of Minnesota, Minneapolis, Minnesota
| | | | - Ramachandra P Tummala
- Departments of 1 Radiology.,Neurosurgery, and.,Neurology, University of Minnesota, Minneapolis, Minnesota
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Curative embolization of pediatric intracranial arteriovenous malformations using Onyx: the role of new embolization techniques on patient outcomes. Neuroradiology 2016; 58:585-594. [DOI: 10.1007/s00234-016-1666-1] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2015] [Accepted: 02/12/2016] [Indexed: 11/26/2022]
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Bongetta D, Lafe E, Pugliese R, Cattalani A, Gaetani P, Thyrion FZ. Endovascular embolization of pial arteriovenous fistula fed from P1 segment of posterior cerebral artery in 12 years old girl: case report and review of literature. Neuroradiol J 2015; 28:268-73. [PMID: 26246094 DOI: 10.1177/1971400915589690] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE Intracranial pial arteriovenous fistulas (PAVFs) are rare vascular lesions with peculiar epidemiological, morphological, and pathophysiological characteristics. Since there is no nidus, PAVF treatment has been performed by direct disconnection of the arteriovenous communication via a surgical, endovascular, or a combined approach. We aim to outline the relevant variables to consider in planning an endovascular treatment strategy. METHODS We present a case of a 12 year old girl with a single feeder PAVF originating from the first segment (P1) of the left posterior cerebral artery with a varicose venous drainage into the right cavernous sinus. RESULTS We report the successful endovascular exclusion of the fistula with the release of a total of 27 detachable platinum coils with no complications at follow-up. Treatment strategy and nuances are discussed along with a review of the literature. CONCLUSIONS Morphology, age, embolization strategies, and materials are the different variables to be analyzed in the endovascular treatment of such lesions.
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Affiliation(s)
- Daniele Bongetta
- Department of Clinical-Surgical, Diagnostic and Pediatric Sciences, Università degli Studi di Pavia, Italy
| | - Elvis Lafe
- Radiodiagnostic and Neuroradiological Unit, Fondazione IRCCS Policlinico S. Matteo, Pavia, Italy
| | | | - Andrea Cattalani
- Department of Clinical-Surgical, Diagnostic and Pediatric Sciences, Università degli Studi di Pavia, Italy
| | - Paolo Gaetani
- Neurosurgery Unit, Fondazione IRCCS Policlinico S. Matteo, Pavia, Italy
| | - Federico Zappoli Thyrion
- Radiodiagnostic and Neuroradiological Unit, Fondazione IRCCS Policlinico S. Matteo, Pavia, Italy
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Howarth RA, Reisner A, Chern JJ, Hayes LL, Burns TG, Berenstein A. Neurocognitive improvements following endovascular repair of vein of Galen malformation in a child. J Neurosurg Pediatr 2015; 15:197-202. [PMID: 25479575 DOI: 10.3171/2014.10.peds14244] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Cognitive regression is a well-described presentation of vein of Galen aneurysmal malformations (VGAMs) in childhood. However, it remains unclear whether successful treatment of the malformation can reverse cognitive regression. Here, the authors present the case of a 5-year-old girl with a VGAM that was treated with staged endovascular embolization procedures. Comprehensive neurocognitive assessments were completed before intervention and approximately 6 years after initial presentation. There were significant age-matched improvements in this child's neurocognitive profile over this period. The authors believe that timely and successful treatment of VGAM in children may not only stabilize the associated cognitive deterioration but, in some cases, may ameliorate these deficits. Details of this case and a discussion of neurocognitive deficits related to VGAM are presented.
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Kim SY, Eun HS, Shin JE, Lee SM, Park MS, Namgung R, Park KI. Intracranial Pial Arteriovenous Fistula Presenting as Brain Hemorrhage in Newborn Infants. NEONATAL MEDICINE 2015. [DOI: 10.5385/nm.2015.22.4.228] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Affiliation(s)
- Soo Yeon Kim
- Division of Neonatology, Department of Pediatrics, Severance Children's Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Ho Seon Eun
- Division of Neonatology, Department of Pediatrics, Severance Children's Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Jeong Eun Shin
- Division of Neonatology, Department of Pediatrics, Severance Children's Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Soon Min Lee
- Division of Neonatology, Department of Pediatrics, Severance Children's Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Min Soo Park
- Division of Neonatology, Department of Pediatrics, Severance Children's Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Ran Namgung
- Division of Neonatology, Department of Pediatrics, Severance Children's Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Kook In Park
- Division of Neonatology, Department of Pediatrics, Severance Children's Hospital, Yonsei University College of Medicine, Seoul, Korea
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Altschul D, Paramasivam S, Ortega-Gutierrez S, Fifi JT, Berenstein A. Safety and efficacy using a detachable tip microcatheter in the embolization of pediatric arteriovenous malformations. Childs Nerv Syst 2014; 30:1099-107. [PMID: 24671157 DOI: 10.1007/s00381-014-2404-9] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2014] [Accepted: 03/14/2014] [Indexed: 10/25/2022]
Abstract
PURPOSE The treatment of deep-seeded pediatric brain arteriovenous malformations (AVMs) remains a challenging task. We describe our experience using a new detachable tip microcatheter in the embolization of brain arteriovenous malformations, pial arteriovenous fistulas, and vein of Galen malformations. We describe the safety and efficacy using a new detachable tip microcatheter in the treatment of pediatric deep brain arteriovenous malformations, pial malformations, and vein of Galen malformations. METHODS During a period of 9 months from March 2013 through January 2014, 11 pediatric patients in 14 procedures with 27 total injections were selected for treatment with a detachable tip under Food and Drug Administration (FDA) compassionate use exemption and were admitted to our department for treatment of their brain AVM using a liquid embolic agent and a detachable tip microcatheter. The ages of the patients ranged from 3 months to 18 years old. RESULTS Of the 27 total injections done, the tip detached in seven cases. For the 16 n-BCA injections, the tip detached six times (37.5 %), and for the 11 Onyx injections, the tip detached one time (9 %). There were no cases of premature microcatheter detachment during normal vessel navigation. CONCLUSIONS The introduction of these detachable tip microcatheters allows for a safe and relaxed injection that permits a true circumferential occlusion, and may further permit filling a larger amount of angioarchitecture without the risk of distal migration, or vessel damage during the usual rapid removal of non detachable micocatheters.
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Affiliation(s)
- David Altschul
- Center for Endovascular Surgery, Hyman-Newman Institute for Neurology and Neurosurgery, Suite 10G, Mount Sinai-Roosevelt Hospital, 1000 Tenth Ave., New York, NY, 10019, USA,
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Kraneburg UM, Nga VDW, Ting EYS, Hui FKH, Lwin S, Teo C, Chou N, Yeo TT. Intracranial pial arteriovenous fistula in infancy: a case report and literature review. Childs Nerv Syst 2014; 30:365-9. [PMID: 23817995 DOI: 10.1007/s00381-013-2217-2] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/23/2013] [Accepted: 06/19/2013] [Indexed: 11/27/2022]
Abstract
Intracranial pial arteriovenous fistulas (AVF) are rare vascular malformation especially in the first 2 years of life. The pathology in this age group is associated with greater morbidity and mortality. We report a rare case of 36-day-old male infant with a pial AVF associated with an arterial aneurysm, who presented with intraventricular hemorrhage and hydrocephalus. In addition, an online review of the literatures on pediatric pial AVF was performed using PubMed on published case reports and articles from 1980 to April 2013.
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Affiliation(s)
- U M Kraneburg
- University of Witten/Herdecke School of Medicine, Witten, Germany
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Toma AK, Davagnanam I, Ganesan V, Brew S. Cerebral Arteriovenous Shunts in Children. Neuroimaging Clin N Am 2013; 23:757-70. [DOI: 10.1016/j.nic.2013.05.001] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Yadav P, De Castro DK, Waner M, Meyer L, Fay A. Vascular Anomalies of the Head and Neck: A Review of Genetics. Semin Ophthalmol 2013; 28:257-66. [DOI: 10.3109/08820538.2013.825279] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
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Venturi C, Bracco S, Cerase A, Cioni S, Galluzzi P, Gennari P, Vallone IM, Tinturini R, Vittori C, De Francesco S, Caini M, D'Ambrosio A, Toti P, Renieri A, Hadjistilianou T. Superselective ophthalmic artery infusion of melphalan for intraocular retinoblastoma: preliminary results from 140 treatments. Acta Ophthalmol 2013; 91:335-42. [PMID: 22268993 DOI: 10.1111/j.1755-3768.2011.02296.x] [Citation(s) in RCA: 45] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
PURPOSE To report our experience in superselective ophthalmic artery infusion of melphalan (SOAIM) for intraocular retinoblastoma. METHODS From June 2008 to October 2010, 38 patients (18 women, 20 men; age range at first treatment, 7 months to 22 years) with 41 eyes with retinoblastoma were scheduled for SOAIM, for 17 newly diagnosed retinoblastomas Tumour, Node and Metastasis (TNM) 7th Edition 1a (n = 1), 1b (n = 1), 2a (n = 7), 2b (n = 4) and 3a (n = 4) and 24 retinoblastomas with partial remission/relapse TNM 7th Edition 1b (n = 13), 2a (n = 1) and 2b (n = 10). Eight patients (ten eyes) have been treated by SOAIM alone. Follow-up was 6-27 months in 28 patients (30 eyes). RESULTS Ophthalmic artery cannulation failed in two patients. Thirty-six patients underwent 140 treatments by internal (n = 112) or external (n = 28) carotid arteries. No major procedural complications occurred. Two patients have been lost to follow-up. Remaining 34 patients (37 eyes) had no metastatic disease. Four patients suffered permanent ocular complications: chorioretinal dystrophy (n = 2), ptosis (n = 1) and strabismus/exotropia (n = 1). Eight (22%) eyes in eight (24%) patients underwent enucleation: 7/16 (43%) newly diagnosed retinoblastomas and 1/22 (4.5%) retinoblastomas undergoing partial remission/relapse. For all treated eyes, Kaplan-Meier eye enucleation-free rates (K-M) were 85.4% (95% CI, 73.3-97.5%), 74.4% (95% CI, 57-91.8%) and still stable at 6, 12 months and 2 years, respectively. For eyes with partial remission/relapse, and eyes at presentation, K-M at 2 years were 95.5% (95% CI, 86.9-100%) and 45.6% (95% CI, 16.6-74.6%), respectively. CONCLUSION Superselective ophthalmic artery infusion of melphalan was safe and powerful, especially following other therapies. Superselective ophthalmic artery infusion of melphalan should be added to focal therapies spectrum. In selected cases, melphalan should be combined with other chemotherapeutic agents.
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Affiliation(s)
- Carlo Venturi
- Unit NINT Neuroimaging and Neurointervention, Department of Neurological and Sensorineural Sciences, Azienda Ospedaliera Universitaria Senese, Policlinico Santa Maria alle Scotte, Siena, Italy.
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Prise en charge des malformations vasculaires cérébrales découvertes en période ante- ou néonatale. Arch Pediatr 2013; 20:74-81. [DOI: 10.1016/j.arcped.2012.10.019] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2012] [Revised: 10/02/2012] [Accepted: 10/26/2012] [Indexed: 11/22/2022]
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Cohen JE, Gomori JM, Benifla M, Itshayek E, Moscovici S. Endovascular management of sigmoid sinus dural arteriovenous fistula associated with sinus stenosis in an infant. J Clin Neurosci 2012; 20:168-70. [PMID: 23010427 DOI: 10.1016/j.jocn.2012.06.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2012] [Accepted: 06/06/2012] [Indexed: 11/17/2022]
Abstract
A 4-month-old female presented with a dural arteriovenous fistula (DAVF), which was successfully managed using endovascular techniques. There are very few case series reporting DAVF in infants younger than 12 months and, to our knowledge, only 60 pediatric patients with DAVF have been reported to date. Although most DAVF have a benign course, they can result in life-threatening hemorrhage. Endovascular therapies are usually indicated in the management of these neurosurgical vascular malformations. Endovascular therapy of DAVF in neonatal patients presents some major issues. Gaining arterial access may be problematic in femoral arteries too small for the introduction of a sizeable guiding catheter. The volumes of contrast and infused fluids must be carefully monitored to prevent fluid overload. Radiation exposure should be restricted as far as possible. This report contributes to the limited body of evidence on neonatal DAVF and its endovascular management.
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Affiliation(s)
- José E Cohen
- Department of Neurosurgery, Hadassah-Hebrew University Medical Center, P.O. Box 12000, Jerusalem 91120, Israel.
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Neurogenic stunned myocardium after embolization in two children with vein of Galen aneurysmal malformation. Neuroradiology 2012; 55:213-6. [DOI: 10.1007/s00234-012-1088-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2012] [Accepted: 08/27/2012] [Indexed: 10/27/2022]
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