Zhang Yi,Xue Ping,Liao Yujun,et al.Clinical manifestations,vascular architecture characteristics and treatment outcomes of pediatric cerebral arteriovenous fistula[J].Journal of Clinical Pediatric Surgery,2025,(02):109-113.[doi:10.3760/cma.j.cn101785-202412015-002]
Clinical manifestations,vascular architecture characteristics and treatment outcomes of pediatric cerebral arteriovenous fistula
- Keywords:
- Arteriovenous Fistula; Brain; Symptoms and Signs; Interventional Therapy; Gamma Knife Treatment; Child
- Abstract:
- Objective To summarize the treatment protocols and clinical outcomes of pediatric cerebral arteriovenous fistula (AVF) and explore the clinical and radiological characteristics as well as factors associated with therapeutic efficacy. Methods A retrospective analysis was conducted for the relevant clinical data of 24 children with cerebral AVF admitted into Department of Neurosurgery,Children’s Hospital of Fudan University from October 2016 to October 2024.The clinical manifestations,radiological features,treatment protocols and prognostic follow-ups were summarized. Results There were 16 boys and 8 girls with an average age of (3.1±2.89 year)(2.5 month-10 year).The clinical manifestations included hemiplegia (n=7),intracranial hemorrhage (n=7),epilepsy (n=7),developmental delay (n=6),facial and scalp venous dilation (n=5),headache (n=5),expanded head circumference (n=4),heart failure in 1 case and exophthalmos (n=1).The clinical types were pial AVF (n=15),dural AVF (n=4) and Galen vein aneurysmal malformation (n=5).All of them received interventional treatment and 6 cases had gamma knife treatment after interventional therapy.During a follow-up period of (51.7±26.39)(6.9-98.3) month.the outcomes were radiological cure (n=10) and good clinical prognosis (n=18).Presence of venous sinus reflux (P=0.017),co-existence of other vascular malformations (P=0.046),occurrence of postoperative complications (P=0.011) and radiological cure (P=0.017) were risk factors affecting clinical outcomes.Multiple arterial supplies (P<0.001),multiple fistulas (P=0.005) and drainage through transverse sinus (P=0.034) were factors associated with radiological cure. Conclusions Pediatric cerebral AVF presents with diverse clinical manifestations.Endovascular interventional treatment is both safe and effective and its efficacy is correlated with vascular architecture of AVF.Complete obliteration of fistula contributes to favorable clinical outcomes.
References:
[1] Berenstein A,Ortiz R,Niimi Y,et al.Endovascular management of arteriovenous malformations and other intracranial arteriovenous shunts in neonates,infants,and children[J].Childs Nerv Syst,2010,26(10):1345-1358.DOI:10.1007/s00381-010-1206-y.
[2] Lv XL,Jiang CH,Wang J.Pediatric intracranial arteriovenous shunts:advances in diagnosis and treatment[J].Eur J Paediatr Neurol,2020,25:29-39.DOI:10.1016/j.ejpn.2019.12.025.
[3] Terada A,Komiyama M,Ishiguro T,et al.Nationwide survey of pediatric intracranial arteriovenous shunts in Japan:Japanese Pediatric Arteriovenous Shunts Study (JPAS)[J].J Neurosurg Pediatr,2018,22(5):550-558.DOI:10.3171/2018.5.PEDS18123.
[4] Maleknia PD,Hale AT,Savage C,et al.Characteristics and outcomes of pediatric dural arteriovenous fistulas:a systematic review[J].Childs Nerv Syst,2024,40(1):197-204.DOI:10.1007/s00381-023-06156-z.
[5] Su X,Ma YJ,Song ZH,et al.Paediatric intracranial dural arteriovenous fistulas:clinical characteristics,treatment outcomes and prognosis.Stroke Vasc Neurol:svn-2024-003122.https://doi.org/10.1136/svn-2024-003122.DOI:10.1136/svn-2024-003122.
[6] Cohen JE,Gomori JM,Benifla M,et al.Endovascular management of sigmoid sinus dural arteriovenous fistula associated with sinus stenosis in an infant[J].J Clin Neurosci,2013,20(1):168-170.DOI:10.1016/j.jocn.2012.06.001.
[7] Madsen PJ,Lang SS,Pisapia JM,et al.An institutional series and literature review of pial arteriovenous fistulas in the pediatric population:clinical article[J].J Neurosurg Pediatr,2013,12(4):344-350.DOI:10.3171/2013.6.PEDS13110.
[8] Li JW,Ji ZL,Yu JX,et al.Angioarchitecture and prognosis of pediatric intracranial pial arteriovenous fistula[J].Stroke Vasc Neurol,2023,8(4):292-300.DOI:10.1136/svn-2022-001979.
[9] Niimi Y.Endovascular treatment of pediatric intracranial arteriovenous shunt[J].Pediatr Int,2017,59(3):247-257.DOI:10.1111/ped.13159.
[10] Li JW,Zeng G,Zhi XL,et al.Pediatric perimedullary arteriovenous fistula:clinical features and endovascular treatments[J].J Neurointerv Surg,2019,11(4):411-415.DOI:10.1136/neurintsurg-2018-014184.
[11] Thrash GW,Hale AT,Feldman MJ,et al.Pediatric non-galenic pial arteriovenous fistula’s characteristics and outcomes:a systematic review[J].Childs Nerv Syst,2024,40(6):1721-1729.DOI:10.1007/s00381-024-06352-5.
[12] Agarwal H,Sebastian LJD,Gaikwad SB,et al.Vein of Galen aneurysmal malformation-clinical and angiographic spectrum with management perspective:an institutional experience[J].J Neurointerv Surg,2017,9(2):159-164.DOI:10.1136/neurintsurg-2015-012137.
[13] Zaidi HA,Kalani MYS,Spetzler RF,et al.Multimodal treatment strategies for complex pediatric cerebral arteriovenous fistulas:contemporary case series at Barrow Neurological Institute[J].J Neurosurg Pediatr,2015,15(6):615-624.DOI:10.3171/2014.11.PEDS14468.
Memo
收稿日期:2024-12-5。
基金项目:国家自然科学基金(82101810)
通讯作者:李昊,Email:li_hao@fudan.edu.cn