[Experience in the treatment for intracranial arteriovenous shunts in children].
OBJECTIVE
To report our experiences in the treatment for intracranial arteriovenous shunts (AV shunts) in the pediatric population.


METHODS
Twelve children with intracranial AV shunts were treated with endovascular embolization between December 1993 and March 2008. These comprised two cases of vein of Galen aneurysmal malformation, three of dural sinus malformation, two of infantile dural AV shunt, five of pial AV fistula including two of vein of Galen aneurysmal dilatation. There were eleven boys and one girl. The age at the first embolization ranged from day 0 to 9 years. We reviewed their clinical features and outcomes.


RESULTS
Six patients including four neonates presented with congestive heart failure, one infant with macrocrania and three children with headache, seizure or ataxia. The number of endovascular embolization ranged from one to five per patient. These included eighteen transarterial embolizations and ten transvenous embolizations. All patients except for one who died eventually from pulmonary hemorrhage showed improvement in their symptoms. Although only five patients achieved complete occlusion of AV shunts, six patients including them developed normally.


CONCLUSIONS
Intracranial AV shunts in the pediatric population present characteristic clinical features depending on the age of the presentation. Endovascular embolization is currently the treatment of choice for them. It is more important to obtain normal development than to achieve normal morphological appearance. It is also important to understand the difference of pathophysiological features of these diseases in the pediatric and adult population.
Ishiguro
Tomoya
T
Department of Neurosurgery, Osaka City General Hospital, 2-13-22 Miyakojimahondori, Miyakojima-ku, Osaka 534-0021, Japan.
Komiyama
Masaki
M
Nakamura
Kazuhito
K
Yoshimura
Masaki
M
Yamamoto
Naoki
N
Yamanaka
Kazuhiro
K
Iwai
Yoshiyasu
Y
Kunihiro
Noritsugu
N
Matsusaka
Yasuhiro
Y
Sakamoto
Hiroaki
H
D002648:Child; D002675:Child, Preschool; D004621:Embolization, Therapeutic; D005260:Female; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D002538:Intracranial Arteriovenous Malformations / Q000150:complications / Q000628:therapy*; D008297:Male