Pediatric intracranial nongalenic pial arteriovenous fistulas: Clinical features, angioarchitecture, and outcomes

Steven W. Hetts, K. Keenan, H. J. Fullerton, W. L. Young, J. D. English, N. Gupta, C. F. Dowd, R. T. Higashida, M. T. Lawton, V. V. Halbach

Research output: Contribution to journalArticle

38 Citations (Scopus)

Abstract

BACKGROUND AND PURPOSE: NGAVFs are rare vascular malformations usually presenting in infancy or childhood. We sought to identify clinical and angiographic predictors of clinical outcome for these lesions. MATERIALS AND METHODS: Retrospective review of a neurointerventional data base identified 386 pediatric patients with intracranial AVFs and AVMs, from which a cohort of 25 patients with NGAVF were selected for medical record and imaging analysis. RESULTS: NGAVFs constituted 7.3% of pediatric intracranial vascular lesions with a nondural arteriovenous shunt. Seven of 8 patients who presented in the first month of life had CHF and harbored large, complex fistulas with multiple sites of arteriovenous shunting. Single-hole fistulas predominated later in childhood and more frequently presented with seizures, hemorrhage, or focal neurologic deficits. More treatment procedures were performed in subjects presenting at ≤2 years of age compared with older children (median = 3 versus 2, P = .041), and in those harboring a multi-hole fistula versus those with a single-hole fistula (median = 3 versus 2, P = .003). Eighteen patients (72%) had complete posttreatment elimination of NGAVF shunting. Compared with patients presenting at >2 years of age, patients presenting in the first 2 years of life were more likely to have a multi-hole fistula (100% versus 25%, P = .0001) and to have a poor clinical outcome (54% versus 0%, P = .0052), defined as a pediatric mRS of ≥3. CONCLUSIONS: The morbidity of NGAVF appears higher than previously reported despite a somewhat higher rate of angiographic cure. Poor clinical outcome occurred primarily in patients with multi-hole NGAVFs presenting at ≤2 years of age.

Original languageEnglish (US)
Pages (from-to)1710-1719
Number of pages10
JournalAmerican Journal of Neuroradiology
Volume33
Issue number9
DOIs
StatePublished - Oct 1 2012
Externally publishedYes

Fingerprint

Arteriovenous Fistula
Pediatrics
Fistula
Vascular Malformations
Diagnostic Imaging
Neurologic Manifestations
Medical Records
Blood Vessels
Seizures
Databases
Hemorrhage
Morbidity

ASJC Scopus subject areas

  • Radiology Nuclear Medicine and imaging
  • Clinical Neurology

Cite this

Pediatric intracranial nongalenic pial arteriovenous fistulas : Clinical features, angioarchitecture, and outcomes. / Hetts, Steven W.; Keenan, K.; Fullerton, H. J.; Young, W. L.; English, J. D.; Gupta, N.; Dowd, C. F.; Higashida, R. T.; Lawton, M. T.; Halbach, V. V.

In: American Journal of Neuroradiology, Vol. 33, No. 9, 01.10.2012, p. 1710-1719.

Research output: Contribution to journalArticle

Hetts, SW, Keenan, K, Fullerton, HJ, Young, WL, English, JD, Gupta, N, Dowd, CF, Higashida, RT, Lawton, MT & Halbach, VV 2012, 'Pediatric intracranial nongalenic pial arteriovenous fistulas: Clinical features, angioarchitecture, and outcomes', American Journal of Neuroradiology, vol. 33, no. 9, pp. 1710-1719. https://doi.org/10.3174/ajnr.A3194
Hetts, Steven W. ; Keenan, K. ; Fullerton, H. J. ; Young, W. L. ; English, J. D. ; Gupta, N. ; Dowd, C. F. ; Higashida, R. T. ; Lawton, M. T. ; Halbach, V. V. / Pediatric intracranial nongalenic pial arteriovenous fistulas : Clinical features, angioarchitecture, and outcomes. In: American Journal of Neuroradiology. 2012 ; Vol. 33, No. 9. pp. 1710-1719.
@article{50395779de4d4147a3bf082de22420b1,
title = "Pediatric intracranial nongalenic pial arteriovenous fistulas: Clinical features, angioarchitecture, and outcomes",
abstract = "BACKGROUND AND PURPOSE: NGAVFs are rare vascular malformations usually presenting in infancy or childhood. We sought to identify clinical and angiographic predictors of clinical outcome for these lesions. MATERIALS AND METHODS: Retrospective review of a neurointerventional data base identified 386 pediatric patients with intracranial AVFs and AVMs, from which a cohort of 25 patients with NGAVF were selected for medical record and imaging analysis. RESULTS: NGAVFs constituted 7.3{\%} of pediatric intracranial vascular lesions with a nondural arteriovenous shunt. Seven of 8 patients who presented in the first month of life had CHF and harbored large, complex fistulas with multiple sites of arteriovenous shunting. Single-hole fistulas predominated later in childhood and more frequently presented with seizures, hemorrhage, or focal neurologic deficits. More treatment procedures were performed in subjects presenting at ≤2 years of age compared with older children (median = 3 versus 2, P = .041), and in those harboring a multi-hole fistula versus those with a single-hole fistula (median = 3 versus 2, P = .003). Eighteen patients (72{\%}) had complete posttreatment elimination of NGAVF shunting. Compared with patients presenting at >2 years of age, patients presenting in the first 2 years of life were more likely to have a multi-hole fistula (100{\%} versus 25{\%}, P = .0001) and to have a poor clinical outcome (54{\%} versus 0{\%}, P = .0052), defined as a pediatric mRS of ≥3. CONCLUSIONS: The morbidity of NGAVF appears higher than previously reported despite a somewhat higher rate of angiographic cure. Poor clinical outcome occurred primarily in patients with multi-hole NGAVFs presenting at ≤2 years of age.",
author = "Hetts, {Steven W.} and K. Keenan and Fullerton, {H. J.} and Young, {W. L.} and English, {J. D.} and N. Gupta and Dowd, {C. F.} and Higashida, {R. T.} and Lawton, {M. T.} and Halbach, {V. V.}",
year = "2012",
month = "10",
day = "1",
doi = "10.3174/ajnr.A3194",
language = "English (US)",
volume = "33",
pages = "1710--1719",
journal = "American Journal of Neuroradiology",
issn = "0195-6108",
publisher = "American Society of Neuroradiology",
number = "9",

}

TY - JOUR

T1 - Pediatric intracranial nongalenic pial arteriovenous fistulas

T2 - Clinical features, angioarchitecture, and outcomes

AU - Hetts, Steven W.

AU - Keenan, K.

AU - Fullerton, H. J.

AU - Young, W. L.

AU - English, J. D.

AU - Gupta, N.

AU - Dowd, C. F.

AU - Higashida, R. T.

AU - Lawton, M. T.

AU - Halbach, V. V.

PY - 2012/10/1

Y1 - 2012/10/1

N2 - BACKGROUND AND PURPOSE: NGAVFs are rare vascular malformations usually presenting in infancy or childhood. We sought to identify clinical and angiographic predictors of clinical outcome for these lesions. MATERIALS AND METHODS: Retrospective review of a neurointerventional data base identified 386 pediatric patients with intracranial AVFs and AVMs, from which a cohort of 25 patients with NGAVF were selected for medical record and imaging analysis. RESULTS: NGAVFs constituted 7.3% of pediatric intracranial vascular lesions with a nondural arteriovenous shunt. Seven of 8 patients who presented in the first month of life had CHF and harbored large, complex fistulas with multiple sites of arteriovenous shunting. Single-hole fistulas predominated later in childhood and more frequently presented with seizures, hemorrhage, or focal neurologic deficits. More treatment procedures were performed in subjects presenting at ≤2 years of age compared with older children (median = 3 versus 2, P = .041), and in those harboring a multi-hole fistula versus those with a single-hole fistula (median = 3 versus 2, P = .003). Eighteen patients (72%) had complete posttreatment elimination of NGAVF shunting. Compared with patients presenting at >2 years of age, patients presenting in the first 2 years of life were more likely to have a multi-hole fistula (100% versus 25%, P = .0001) and to have a poor clinical outcome (54% versus 0%, P = .0052), defined as a pediatric mRS of ≥3. CONCLUSIONS: The morbidity of NGAVF appears higher than previously reported despite a somewhat higher rate of angiographic cure. Poor clinical outcome occurred primarily in patients with multi-hole NGAVFs presenting at ≤2 years of age.

AB - BACKGROUND AND PURPOSE: NGAVFs are rare vascular malformations usually presenting in infancy or childhood. We sought to identify clinical and angiographic predictors of clinical outcome for these lesions. MATERIALS AND METHODS: Retrospective review of a neurointerventional data base identified 386 pediatric patients with intracranial AVFs and AVMs, from which a cohort of 25 patients with NGAVF were selected for medical record and imaging analysis. RESULTS: NGAVFs constituted 7.3% of pediatric intracranial vascular lesions with a nondural arteriovenous shunt. Seven of 8 patients who presented in the first month of life had CHF and harbored large, complex fistulas with multiple sites of arteriovenous shunting. Single-hole fistulas predominated later in childhood and more frequently presented with seizures, hemorrhage, or focal neurologic deficits. More treatment procedures were performed in subjects presenting at ≤2 years of age compared with older children (median = 3 versus 2, P = .041), and in those harboring a multi-hole fistula versus those with a single-hole fistula (median = 3 versus 2, P = .003). Eighteen patients (72%) had complete posttreatment elimination of NGAVF shunting. Compared with patients presenting at >2 years of age, patients presenting in the first 2 years of life were more likely to have a multi-hole fistula (100% versus 25%, P = .0001) and to have a poor clinical outcome (54% versus 0%, P = .0052), defined as a pediatric mRS of ≥3. CONCLUSIONS: The morbidity of NGAVF appears higher than previously reported despite a somewhat higher rate of angiographic cure. Poor clinical outcome occurred primarily in patients with multi-hole NGAVFs presenting at ≤2 years of age.

UR - http://www.scopus.com/inward/record.url?scp=84867754035&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=84867754035&partnerID=8YFLogxK

U2 - 10.3174/ajnr.A3194

DO - 10.3174/ajnr.A3194

M3 - Article

C2 - 22766672

AN - SCOPUS:84867754035

VL - 33

SP - 1710

EP - 1719

JO - American Journal of Neuroradiology

JF - American Journal of Neuroradiology

SN - 0195-6108

IS - 9

ER -