Embolisation of Cerebral Arteriovenous Shunts in Low-Weight Infants

Context: This study aims to describe the clinical and radiological findings, timing and type of endovascular treatment and early outcome in low-weight children that presented neurovascular malformations.

Methods: A retrospective review of all consecutive children weighing less than 5 kg with neurovascular arteriovenous malformations was performed at a single institution between 2006 and 2015.

Results: A total of 53 patients were included. Among them, 38 had a vein of Galen aneurysmal malformation (VGAM), four a pial arteriovenous malformation (AVM), six a pial arteriovenous fistula and five a dural sinus malformation (DSM). In all cases, a unilateral 4F catheter was used as an introducer and each embolisation was performed in coaxial fashion through the 4F catheter. The treatment goals were to control cardiac failure or hydrocephalus in non-hemorrhagic malformations, or to prevent new bleeding in the case of a previous hemorrhage. A hemorrhagic complication occurred in 12 procedures and an ischemic complication in two. Both were correlated with the age of the infant (threshold = 3 months) with the respective p-value = 0.015 and 0.049. No correlation was found with the age of the infant or the length of the procedure.

Conclusions: The embolisation of arteriovenous malformations in low-weight infants prevents adverse cardiac effects, hydrovenous disorders and rebleeding. The risk of major cerebral complications seems mainly correlated with age, with a threshold at three months. A multidisciplinary team usually involved in the treatment of these children may help to improve treatment success and management.