1 - Serviço de Neurorradiologia, Hospital Dona Estefânia, Centro Hospitalar Universitário de Lisboa Central, Lisboa;
2 - NOVA Medical School, Universidade Nova de Lisboa, Lisboa;
3 - Unidade de Neuropediatria, Área de Pediatria, Hospital de Dona Estefânia, Centro Hospitalar Universitário de Lisboa Central, Lisboa;
4 - Serviço de Neurocirurgia, Hospital Dona Estefânia, Centro Hospitalar e Universitário de Lisboa Central, Lisboa;
- Artigo publicado Journal of neurological surgery. Part A, Central European neurosurgery 2023, DOI: 10.1055/s-0043-1770356.
Introdução: Brain arteriovenous malformations (bAVMs) are abnormal vascular connections with direct arteriovenous shunts, generally symptomatic in the adult life. However, a small number of bAVMs may manifest in pediatric patients, with higher bleeding risk and mortality rates when compared to adults.
Objetivos: Review our experience with endovascular treatment of bAVMs in pediatric patients.
Métodos: Retrospective analysis of all bAVMs in pediatric patients (0–18 years) who underwent diagnostic digital subtraction angiography (DSA) at our institution from January 2010 to June 2021.
Resultados: Twenty-six patients met the inclusion criteria, of which 12 underwent endovascular treatment. Treated patients had a mean age of 10.25 years and 58% were females. Complete angiographic exclusion was achieved in five (42%) patients with endovascular treatment. Five patients with residual bAVM after embolization needed adjuvant therapy with surgery (n = 3) or stereotactic radiosurgery (SRS; n = 2). Two patients are still undergoing embolization sessions. Procedure-related complications occurred in two patients (17%) and included small vessel perforation and an occipital ischemic stroke. Two patients showed bAVM recurrence on follow-up (17%) and subsequently underwent SRS (n = 1) or surgery (n = 1), both resulting in complete bAVM exclusion. All patients had a modified Rankin scale (mRS) score of 0 to 2 on follow-up.
Conclusões: Our experience supports the effectiveness and safety of endovascular treatment of bAVM in selected pediatric patients. A multidisciplinary approach combining surgery and SRS is warranted to achieve higher complete bAVM obliteration rates. Long-term follow-up is important as these lesions may show recurrence over time, especially in the pediatric population.
Palavras Chave: Embolização endovascular, hemorragia intracraniana, malformações arteriovenosas cerebrais pediátricas.