Encephaloduroarteriosynangiosis for the Treatment of Cerebral Arteriovenous Malformations in the Pediatric Population

TL;DR

This paper presents a case of a child with a severe brain AVM treated using a combination of embolization and EDAS, showing improved outcomes over time.

Contribution

The paper demonstrates the effectiveness of EDAS, typically used for moyamoya disease, in treating high-grade pediatric AVMs.

Findings

The patient showed improved motor function after multimodal treatment for a high-grade AVM.

EDAS helped mitigate ischemia and promote collateral neovascularization in the patient.

Transient postoperative worsening of symptoms occurred but gradually improved with long-term follow-up.

Abstract

Arteriovenous malformations (AVMs) in the pediatric population are rare but represent a critical cause of spontaneous intracranial hemorrhage. Here we present the case of an 11-year-old boy who developed acute-onset left-sided weakness, slurred speech, and transient hemiparesis. While initial laboratory findings were unremarkable, brain magnetic resonance imaging revealed a large right cerebral AVM. Cerebral angiography confirmed this finding, showing a Spetzler-Martin grade V AVM, supplied by the middle, anterior, and posterior cerebral arteries. The patient was treated using a multimodal approach, including embolization and encephaloduroarteriosynangiosis (EDAS). Postoperatively, he experienced transient worsening of hemiparesis of unknown etiology, which gradually improved. Long-term follow-up demonstrated improved motor function with persistent mild left-sided weakness. This case highlights the significance of multimodal management in high-grade pediatric AVMs. This particular includes the utility of EDAS, originally developed for moyamoya disease, in mitigating ischemia by promoting collateral neovascularization and thus improving neurological symptoms.

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