Dural Arteriovenous Fistula in Children: Endovascular Treatment and Outcomes in Seven Cases
Patricia K. Kincaida,
Gary R. Duckwilera,
Y. Pierre Gobina and
Fernando Viñuelaa
a From the Divisions of Diagnostic (P.K.K.) and Interventional (G.R.D., Y.P.G., F.V.) Neuroradiology at the University of California Los Angeles Medical Center, Center for the Health Sciences, Los Angeles, CA.
View larger version (117K):
[in a new window]
|
FIG 1. Patient 7 was a 10-year-old girl with a complex, multifocal dural AVF (infantile type dural arteriovenous shunt), who presented late with advanced neurologic symptoms.
A, Axial view contrast-enhanced CT scan obtained at the time of referral shows dystrophic calcification in the brain parenchyma, hydrocephalus, thinning of white matter that is abnormally hypodense, and enlarged right sphenoparietal and superior sagittal sinuses. This patient had already developed irreversible brain injury related to her dural AVF.
B, Sagittal view T1-weighted MR image shows a significantly enlarged flow void in the superior sagittal sinus and torcular herophili, some of the sites of arteriovenous shunting in this patient. Also note the prolapse of the cerebellar tonsils at the craniocervical junction, the so-called acquired Chiari I malformation that can also be seen with the vein of Galen malformation.
| |
View larger version (93K):
[in a new window]
|
FIG 2. Patient 1 was a newborn with severe congestive heart failure.
A, Anteroposterior view angiogram of the right external carotid artery shows a large left transverse and sigmoid sinus dural AVF (dural sinus malformation) supplied by enlarged right occipital artery branches, subsequently embolized using coils and N-butylcyanoacrylate. Note the coil mass already present in the left transverse sinus that was placed via direct puncture at an outside institution at 1 day of age.
B, Anteroposterior view shows left common carotid artery injection, venous phase, with prominent venous collateral channels draining to the right transverse sinus.
C, Lateral view shows left external carotid artery injection before embolization. The large left transverse and sigmoid sinus dural AVF is supplied by a markedly enlarged left middle meningeal artery that arises from the left ophthalmic artery. There is abnormal enlargement of the artery of the foramen rotundum (arrowhead) that supplies an enlarged middle meningeal artery (large arrows). The middle meningeal artery has a variant origin from the ophthalmic artery (small arrows).
D, Lateral view shows left common carotid artery injection after embolization. After complete embolization using microcoils and N-butylcyanoacrylate, there is stagnation of flow in the stump of the middle meningeal artery (open arrow), no evidence of arteriovenous shunting, and good filling of the normal intracranial circulation.
| |
View larger version (109K):
[in a new window]
|
FIG 3. Patient 5, with a dural sinus malformation, was an 18-month-old who presented with seizures and prominent facial veins.
A, Anteroposterior view angiogram of the right external carotid artery, venous phase, shows bilateral sigmoid sinus occlusions and an enlarged occipital vein. The arterial phase (not shown) showed enlarged right occipital artery feeders to a large right transverse sinus dural fistula.
B, Lateral view angiogram of the right common carotid artery, obtained after complete embolization of the dural AVF, shows development of collateral venous drainage, ultimately draining through the superior ophthalmic veins (arrow), which is seen to be markedly dilated.
| |
