Dural arteriovenous fistula in children: Endovascular treatment and outcomes in seven cases

BACKGROUND AND PURPOSE: Dural AVF is a vascular anomaly that rarely occurs in children and is best treated by endovascular embolization. We report our experience using various endovascular embolization techniques in the treat ment of dural AVF in a pediatric population. METHODS: Seven children with angiographically proven dural AVF were treated with endovascular embolization using microcoils, N-butylcyanoacrylate, det achable balloons, and/or silk suture. All imaging studies, embolization pro cedures, and patient charts were retrospectively reviewed. RESULTS: Seven children had been treated for dural AVF at our institution s ince 1987, Three newborns presented with congestive heart failure. Four old er children (10 months-10 years) presented with signs referable to venous h ypertension, including seizures, hydrocephalus, and proptosis. Embolization approaches included transarterial, transvenous, and direct puncture after neurosurgical exposure of a dural sinus. The number of embolizations ranged from 1 to 13 sessions per patient. All patients experienced symptomatic im provement after each embolization session. The three newborns showed marked improvement in cardiac function that allowed discharge to home. Clinical f ollow-up ranged from 3 weeks to 9 years (mean, 4.1 years). Two children wit h partially embolized dural AVF died, and one was lost to follow-up. Four c hildren are alive after complete embolization of their dural AVF; two are d evelopmentally normal, and two have mild developmental delay. CONCLUSION: Endovascular embolotherapy is the current treatment of choice f or dural AVF. Embolization therapy may be life saving in the setting of car diac failure and curative in cases of small or simple fistulae. Multiple, c omplex dural AVF are usually not curable, and treatment is aimed at symptom atic relief. Treatment strategies focus on the location and/or complexity o f the fistula, the patient's clinical status, and the neurologic prognosis.