Embolization of cerebral arteriovenous shunts in infants weighing less than 5 kg

Francesco Puccinelli , Minh Ngoc Thien Kim Tran Dong , Marta Iacobucci , Jean-Xavier Mazoit , Philippe Durand , Pierre Tissieres (1, 2) , Guillaume Saliou

1 I2BC - Institut de Biologie Intégrative de la Cellule
2 ESHR - Endotoxines, Structures et Réponses de l'hôte

OBJECTIVEEndovascular treatment in children, especially neonates, can be more challenging than analogous procedures in adults. This study aimed to describe the clinical and radiological findings, type and timing of endovascular treatment, and early outcomes in children who present with neurovascular malformations, who are treated with embolization, and who weigh less than 5 kg.METHODSThe authors carried out a retrospective review of all consecutively treated children weighing less than 5 kg with neurovascular arteriovenous malformations (AVMs) at a single institution over a 10-year period.RESULTSFifty-two patients were included in the study. Thirty-eight had a vein of Galen aneurysmal malformation, 3 a pial AVM, 6 a pial arteriovenous fistula, and 5 a dural sinus malformation. The endovascular treatment goals were control of cardiac failure or hydrocephalus in cases of nonhemorrhagic malformations or to prevent new bleeding in cases of previous hemorrhage. A hemorrhagic complication occurred in 12 procedures and an ischemic complication in 2. Both complication types were correlated with the age of the infant (age cutoff at 3 months) (p = of 0.015 and 0.049, respectively). No correlation was found with the weight of the infant or the duration of the procedure.CONCLUSIONSThe embolization of AVMs in these patients prevented adverse cardiac effects, hydrovenous disorders, and rebleeding. The risk of major cerebral complications seems mainly correlated with age, with a threshold at 3 months. A multidisciplinary team involved in the treatment of these children may help to improve treatment success and management.

Mots clés: children; AVF = arteriovenous fistula; AVM = arteriovenous malformation; cerebral AVM; DSM = dural sinus malformation; embolization; endovascular treatment; ICA = internal carotid artery; KOSCHI = King’s Outcome Scale for Childhood Head Injury; neurovascular disease; newborn; vascular disorders; VGAM = vein of Galen aneurysmal malformation

Domaines: Sciences du Vivant [q-bio]

Francesco Puccinelli, Minh Ngoc Thien Kim Tran Dong, Marta Iacobucci, Jean-Xavier Mazoit, Philippe Durand, et al.. Embolization of cerebral arteriovenous shunts in infants weighing less than 5 kg. Journal of Neurosurgery. Pediatrics, 2019, pp.1--9. ⟨10.3171/2018.11.PEDS1865⟩. ⟨hal-02531023⟩