Experience in the Treatment for Intracranial Arteriovenous Shunts in Children Tomoya ISHIGURO 1 , Masaki KOMIYAMA 1 , Kazuhito NAKAMURA 1 , Masaki YOSHIMURA 1 , Naoki YAMAMOTO 1 , Kazuhiro YAMANAKA 1 , Yoshiyasu IWAI 1 , Noritsugu KUNIHIRO 2 , Yasuhiro MATSUSAKA 2 , Hiroaki SAKAMOTO 2 1Department of Neurosurgery,Osaka City General Hospital 2Department of Pediatric Neurosurgery,Osaka City General Hospital Keyword: intracranial arteriovenous shunt , children , endovascular embolization pp.543-550
Published Date 2009/6/10
DOI https://doi.org/10.11477/mf.1436100954
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 Purpose: To report our experiences in the treatment for intracranial arteriovenous shunts (AV shunts) in the pediatric population.

 Material and methods: Twelve children with intracranial AV shunts were treated with endovascular embolization between December 1993 and March 2008. These comprised two cases of vein of Galen aneurysmal malformation, three of dural sinus malformation, two of infantile dural AV shunt, five of pial AV fistula including two of vein of Galen aneurysmal dilatation. There were eleven boys and one girl. The age at the first embolization ranged from day 0 to 9 years. We reviewed their clinical features and outcomes.

 Results: Six patients including four neonates presented with congestive heart failure, one infant with macrocrania and three children with headache, seizure or ataxia. The number of endovascular embolization ranged from one to five per patient. These included eighteen transarterial embolizations and ten transvenous embolizations. All patients except for one who died eventually from pulmonary hemorrhage showed improvement in their symptoms. Although only five patients achieved complete occlusion of AV shunts, six patients including them developed normally.

 Conclusion: Intracranial AV shunts in the pediatric population present characteristic clinical features depending on the age of the presentation. Endovascular embolization is currently the treatment of choice for them. It is more important to obtain normal development than to achieve normal morphological appearance. It is also important to understand the difference of pathophysiological features of these diseases in the pediatric and adult population.

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