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Original research
Pediatric perimedullary arteriovenous fistula: clinical features and endovascular treatments
  1. Jingwei Li1,
  2. Gao Zeng1,
  3. Xinglong Zhi1,
  4. Lisong Bian2,
  5. Fan Yang3,
  6. Jianxin Du1,
  7. Feng Ling1,
  8. Hongqi Zhang1
  1. 1 Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, China
  2. 2 Department of Neurosurgery, Beijing Haidian Hospital, Beijing, China
  3. 3 Department of Neurosurgery, Beijing United Family Hospital, Beijing, China
  1. Correspondence to Dr Hongqi Zhang, Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing 100053, China; xwzhanghq{at}163.com

Abstract

Objective Pediatric spinal perimedullary arteriovenous fistula (PMAVF) is rare but may cause permanent disability. We aim to summarize the clinical features of pediatric PMAVFs and our clinical experience in their treatment and to evaluate the effect of endovascular treatment in a large cohort.

Methods From 2008 to 2017, 51 PMAVFs in pediatric patients (<14 years' old) treated with endovascular techniques were retrospectively reviewed, including 24 type IVb (47.1%) and 27 type IVc (52.9%) lesions. Clinical features, radiological findings, treatment, and outcomes were evaluated.

Results Thirty-eight boys and thirteen girls were included, and the mean age at presentation was 5.6±4.1 years. Acute neurological deterioration was identified in 33 patients, and 21 of those patients (63.6%) suffered from bleeding. The annual bleeding rate before treatment was 2.55%. After transarterial embolization with coils and glue, 46 PMAVFs (90.2%) were completely occluded, and five (9.8%) were obliterated by supplementary microsurgery. During a follow-up period of 6 to 119 months (mean 58.4±16.7 months), the patients’ clinical states were improved in 42 cases (82.4%), stationary in nine cases (17.6%), and aggravated in none. Type IVc patients had a longer preoperative period, more chronic symptoms, a lower cure rate by embolization, and less improvement of symptoms than type IVb patients had (P<0.05).

Conclusions Pediatric PMAVF is a special subgroup of intradural arteriovenous shunt that should be treated early. Endovascular embolization is safe and effective in the treatment of pediatric PMAVFs.

  • perimedullary arteriovenous fistula
  • arteriovenous malformation
  • pediatric
  • treatment
  • embolization
  • prognosis
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Footnotes

  • Contributors Conception and design: JW-L, LS-B, F-Y. Acquisition of the data, analysis, and interpretation of the data, and critically revising the article: all authors. Drafting the article: JW-L and G-Z. Reviewed submitted version of manuscript: XL-Zh, JX-D, F-L. Approved the final version of the manuscript on behalf of all authors: HQ-Zh. Administrative/technical/material support: all authors. Study supervision: HQ-Zh.

  • Funding This work was supported by Beijing Municipal Science and Technology Commission, grant number D161100003816001.

  • Competing interests None declared.

  • Patient consent Parental/guardian consent obtained.

  • Ethics approval This study was approved by our institutional ethics committee (Xuanwu Hospital, No.2016032).

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

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