Pk. Kincaid et al., Dural arteriovenous fistula in children: Endovascular treatment and outcomes in seven cases, AM J NEUROR, 22(6), 2001, pp. 1217-1225
Citations number
32
Categorie Soggetti
Radiology ,Nuclear Medicine & Imaging","Neurosciences & Behavoir
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.