Transumbilical arterial embolization of a large dural arteriovenous fistula in a low-birth-weight neonate with congestive heart failure.
OBJECTIVE
The purpose of this study was to report transumbilical arterial embolization of a large dural arteriovenous fistula (AVF) in a low-birth-weight neonate with congestive heart failure (CHF).


METHODS
A female neonate was delivered by cesarean section at 31 weeks of gestation. Her birth weight was 1538 g and Apgar scores were 6 at both 1 and 5 min. Because of dyspnea and retracted respiration immediately after birth, she required mechanical ventilation. Ultrasound revealed right cardiac overload and a large cystic mass at the posterior brain. Magnetic resonance imaging on day 1 showed a large dural AVF (dural sinus malformation with arteriovenous (AV) shunts) at the torcular herophili. Umbilical artery and vein catheterization were performed on the same day for neurointervention. CHF prompted emergency embolization on day 8. The transfemoral arterial route could not be used because of its small size and compromised femoral artery blood flow. Transumbilical arterial embolization shrank the AV shunts markedly, resulting in clinical improvement, thus requiring no further intervention. Follow-up angiography at 4 months confirmed no residual AVF. Her growth and development were normal at the last follow-up at age 4 years.


CONCLUSIONS
This patient apparently was the lowest birth weight neonate with a large AVF successfully treated by embolization, which is usually performed through the transfemoral arterial route. The transumbilical arterial route is an alternative for neonates with birth weight <2000 g and very small femoral arteries.
Department of Pediatric Neonatology, Okinawa Prefectural Nanbu Medical Center and Children's Medical Center, Okinawa, Japan.
Tatsuo
T
Oshiro
Department of Pediatric Neonatology, Okinawa Prefectural Nanbu Medical Center and Children's Medical Center, Okinawa, Japan.
Okitaka
O
Nakayama
Department of Pediatric Neonatology, Okinawa Prefectural Nanbu Medical Center and Children's Medical Center, Okinawa, Japan.
Chiaki
C
Ohba
Department of Obstetrics and Gynecology, Okinawa Prefectural Nanbu Medical Center and Children's Medical Center, Okinawa, Japan.
Yoko
Y
Ohashi
Department of Neurosurgery, Sugioka Memorial Hospital, Fukuoka, Japan.
Junichi
J
Kawakubo
Department of Neurosurgery, Okinawa Prefectural Nanbu Medical Center and Children's Medical Center, Okinawa, Japan.
Tomoaki
T
Nagamine
Department of Neuro-Intervention, Osaka City General Hospital, 2-13-22, Miyakojima-Hondori, Miyakojima, Osaka, 534-0021, Japan. komiyama@japan-mail.com.
Masaki
M
Komiyama
D020785:Central Nervous System Vascular Malformations / Q000150:complications* / Q000000981:diagnostic imaging / Q000601:surgery*; D002533:Cerebral Angiography; D002675:Child, Preschool; D004621:Embolization, Therapeutic / Q000379:methods*; D005260:Female; D006333:Heart Failure / Q000150:complications* / Q000000981:diagnostic imaging; D006801:Humans; D007230:Infant, Low Birth Weight; D008137:Longitudinal Studies; D008279:Magnetic Resonance Imaging; D018615:Ultrasonography, Doppler, Color; D014469:Umbilical Arteries / Q000601:surgery*
Dural arteriovenous fistula; Dural sinus malformation; Embolization; Low birth weight; Umbilical approach