Paediatric Spinal Arteriovenous Malformations: Angioarchitecture and Endovascular Treatment

Abstract

This is a retrospective review of the clinical records and imaging of 14 children with spinal arteriovenous malformations referred to the neurointerventional service at our institution. The lesions are categorized by anatomic location into subpial (5 cases), epidural (3 cases), and paraspinal (6 cases).

There were no dural arteriovenous fistulas in this group. The subpial lesions include both the intramedullary arteriovenous malformations (2 cases) and the perimedullary arteriovenous fistulas (3 cases). Two of the patients with perimedullary fistulas were first cousins and both had Rendu-Osler-Weber syndrome. The six paraspinal lesions were vertebral-vertebral fistulas with five of these located at the first cervical metamere.

Eleven cases (79%) were arteriovenous fistulas and three cases (21%) were arteriovenous malformations with a nidus. There were nine (82%) high flow arteriovenous fistulae and two (18%) low flow arteriovenous fistulae. The ages range from seven months to 15 years, with a mean age of seven years.

There were nine males and five females. Clinical presentations included: bruit alone (6 patients), progressive scoliosis (1 patient), pain (2 patients), neurologic deficit (4 patients) and one case of Cobb's syndrome. Management included: no treatment (1 patient), endovascular embolisation (10 patients) and surgery (3 patients). Of the patients who underwent endovascular treatment all were treated from the arterial side. Two patients were treated by N-butyl cyanoacrylate (NBCA) alone, two with NBCA and coils, one with balloons alone, three with balloons and coils and two with coils alone.

In the endovascular treatment group, nine fistulae were completely obliterated (all high flow fistulae) and one patient had partial treatment (a spinal cord arteriovenous malformation). There were no complications from endovascular treatment.