title: Perimedullary arteriovenous fistulas in children: report on six cases.
abstract: BACKGROUND
  Perimedullary arteriovenous fistulas (PMAVFs) are rare spinal lesions and even more uncommon in children.
  
  
  OBJECTIVE
  The aim of this study was to document rare occurrences of this type of arteriovenous malformation in six children treated at our institution.
  
  
  METHODS
  The clinical data, radiological findings, and treatment in six cases of PMAVFs were reviewed. Six patients with PMAVFs were managed at our institution over a 5-year period. The patients (four girls and two boys), ranging in age from 6 to 15 years, presented with initially fluctuating, and eventually permanent and progressive, sudden-onset paraparesis, sensory disturbances, and sphincter dysfunction. The duration of symptoms before diagnosis ranged from 1 week to 13 years.
  
  
  RESULTS
  All the patients underwent magnetic resonance imaging and spinal selective angiography, which demonstrated the characteristic imaging of an arteriovenous fistula. Embolization of the arteriovenous fistula was initially attempted in three patients with successful occlusion of the fistula in two. For the remaining cases, open surgery was performed, with complete occlusion of the fistula. There was no morbidity, regardless of the treatment performed. All the patients experienced neurological improvement after treatment.
  
  
  CONCLUSIONS
  No specific clinical or radiological characteristic of PMAVFs in the pediatric population was observed when our series was compared with a general series. Early diagnosis and timing of the therapeutic intervention seemed to avoid the development of irreversible ischemic myeloradiculopathy and prevented hemorrhage. Treatment for PMAVFs is difficult to standardize because these are extremely rare lesions with different angioarchitecture configurations.
authors: Pediatric Neurosurgery Division, Department of Neurosurgery, University of São Paulo School of Medicine, São Paulo, SP, Brazil. Matushita@uol.com.br
authors: Hamilton
authors: H
authors: Matushita
authors: Jose Guilherme Mendes Pereira
authors: JG
authors: Caldas
authors: Manoel Jacobsen
authors: MJ
authors: Texeira
mesh_terms: D000293:Adolescent; D000792:Angiography; D020785:Central Nervous System Vascular Malformations / Q000473:pathology* / Q000628:therapy*; D002648:Child; D004621:Embolization, Therapeutic; D005260:Female; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008866:Microsurgery; D019635:Neurosurgical Procedures