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Case report
Successful endovascular treatment of a holo-hemispheric cerebral arteriovenous fistula in an infant
  1. Kumar Vasudevan1,
  2. Heather S Spader1,
  3. Jonathan A Grossberg1,
  4. Thomas Murphy2,
  5. Mahesh V Jayaraman1,3
  1. 1Department of Neurosurgery, The Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA
  2. 2Department of Pediatrics, The Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA
  3. 3Department of Diagnostic Imaging, The Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA
  1. Correspondence to Dr Mahesh V Jayaraman, Alpert Medical School at Brown University, 593 Eddy St., Room 377, Providence, RI 2903, USA; mjayaraman{at}lifespan.org

Abstract

A cerebral arteriovenous fistula (CAVF) is a rare abnormality representing only 4.7% of all cerebral arteriovenous malformations. In this report a unique case is presented of a giant holo-hemispheric CAVF in an infant who presented with congestive heart failure and was successfully treated endovascularly with transarterial and transvenous embolization. A 4-day-old girl presented with lethargy and poor feeding and was found to be in congestive heart failure secondary to a large left hemispheric vascular malformation. Embolization was performed via a transarterial route on days of life (DOL) 11 and 18, a transvenous route on DOL 54 and a final transarterial treatment on DOL 76. After all treatment the patient was discharged home on minimal cardiac medications. At 2-year follow-up the patient had moderate motor delays and mild speech delays, but she continued to meet milestones and her cardiac failure was completely resolved. This case demonstrates one of the largest CAVFs treated successfully in the neonatal population.

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Footnotes

  • Competing interests None.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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