[Intracranial arteriovenous vascular lesions in children. Role of endovascular technics apropos of 44 cases]

Abstract

The clinical and radiological files of 44 children with intracranial arteriovenous malformations (AVM (20 AVMs with ectasia of the vein of Galen, 21 parenchymatous or choroid AVMs without ectasia of the vein of Galen and 3 congenital dural AV fistulas) were reviewed. Clinical symptoms, architecture and the used therapy are analyzed. The only specific features of the pediatric population are the clinical systemic manifestations. In comparison to the adult population, a higher percentage of multiple lesions (20%), mostly direct AV fistulas were observed and conversely less associated arterial ectasias. Because of the high mortality associated to the natural history of these lesions in children, one must look for a complete and stable disappearance of the lesion. Among the therapeutic modalities available, embolization has proven a precise and efficient treatment. As the sole treatment, anatomic cure was obtained in 16.6% of patients; significant clinical improvement was obtained in an additional 50% of patients. The morbidity of the technique is low: 3.1% of neurologic complications (all being transitory). Embolizations associated to surgery achieved 3 more anatomic cure. The use of all these combinations allowed us to reach 79.2% of very good results (30.4% of anatomic cure). 3 cases of vein of Galen aneurysms died in our series (newborn during open surgery, one child 24 hours after thrombosis of the vein of Galen by endovascular means, a third one (newborn) one week after partial embolization as a defavorable outcome of major cardiac and hepatic insufficiency.