title: Spinal type IV arteriovenous malformations (perimedullary fistulas) in children.
abstract: OBJECTIVE
  Intradural perimedullary spinal arteriovenous fistula (AVF) is a synonym for type IV spinal arteriovenous malformation (AVM). It is an important clinical differential diagnosis in all patients with slowly progressive or acute spinal symptoms. Perimedullary AVFs are rare in the paediatric age group. We report the treatment regimen and the clinico-radiological findings for these malformations at our institution.
  
  
  METHODS
  Of four paediatric patients, three individuals with persistent fistulas after endovascular treatment were operated on. The malformations were obliterated completely in all patients without any morbidity. In three patients previously documented neurological symptoms resolved during follow-up.
  
  
  CONCLUSIONS
  If slowly progressive or acute radicular or medullary symptoms arise in children, a spinal arteriovenous malformation should be ruled out by MRI. A combined endovascular and surgical treatment of paediatric spinal AVM type IV (perimedullary AVFs) carries a low risk of morbidity and is reasonably effective.
authors.affiliation: Department of Neurosurgery, Philipps University, Marburg, Germany. sure@post.med.uni-marburg.de
authors.forename: U
authors.initials: U
authors.lastname: Sure
authors.forename: J P
authors.initials: JP
authors.lastname: Wakat
authors.forename: S
authors.initials: S
authors.lastname: Gatscher
authors.forename: R
authors.initials: R
authors.lastname: Becker
authors.forename: S
authors.initials: S
authors.lastname: Bien
authors.forename: H
authors.initials: H
authors.lastname: Bertalanffy
mesh_terms: D000293:Adolescent; D000792:Angiography; D001164:Arteriovenous Fistula / Q000151:congenital* / Q000175:diagnosis* / Q000601:surgery; D002648:Child; D005073:Evoked Potentials, Somatosensory / Q000502:physiology; D005260:Female; D006801:Humans; D007430:Intraoperative Care; D008297:Male; D008866:Microsurgery / Q000379:methods; D011182:Postoperative Care; D011300:Preoperative Care; D013116:Spinal Cord / Q000098:blood supply* / Q000601:surgery