Spinal type IV arteriovenous malformations (perimedullary fistulas) in children

Objects: Intradural perimedullary spinal arteriovenous fistula (AVF) is a s ynonym for type IV spinal arteriovenous malformation (AVM). It is an import ant clinical differential diagnosis in all patients with slowly progressive or acute spinal symptoms. Perimedullary AVFs are rare in the paediatric ag e group. We report the treatment regimen and the clinico-radiological findi ngs for these malformations at our institution. Methods: Of four paediatric patients, three individuals with persistent fistulas after endovascular tr eatment were operated on. The malformations were obliterated completely in all patients without any morbidity. In three patients previously documented neurological symptoms resolved during follow-up. Conclusions: If slowly pr ogressive or acute radicular or medullary symptoms arise in children, a spi nal arteriovenous malformation should be ruled out by MRI. A combined endov ascular and surgical treatment of paediatric spinal AVM type IV (perimedull ary AVFs) carries a low risk of morbidity and is reasonably effective.