Endovascular treatment of cerebral arteriovenous malformations [Endovaskulare therapie bei arteriovenosen malformationen des zentralnervensystems im kindesalter]

Background: Endovascular management of cerebral arteriovenous malformations has gained increasing importance in recent years. Based on our own results the potentials and limitations of this therapeutic option are stated. Methods: 19 children with cerebral arteriovenous malformations [vein of Galen malformation (n=7), pial arteriovenous malformations (n=8), AV- fistula of the vertebral arteries (n=4)] underwent superselective transarterial endovascular management of these lesion between 3 months and 17 years of age. Results: Complete angiographic exclusion was achieved in 7 patients. Endovascular pretreatment made subsequent neurosurgical exclusion of a pial arteriovenous malformation possible in one additional patient. The other children profited clinically by significant shunt reduction with improvement or disappearance of their presenting symptoms, all but one are under ongoing endovascular treatment. A 2-year-old girl suffered from massive intracranial hemorrhage following her first embolization therapy with permanent neurologic deficit. Two transient but no permanent neurological complications occurred in the other patients now free of therapy induced neurological deficits after a medium follow-up of 26 (7-95) months. The children treated during infancy develop neurologically normal and without delay. Conclusion: Burdened with a justifiable risk superselective embolization of arterial feeders is a highly effective therapy in cerebral arteriovenous malformations and has been successfully applied even in young infants.