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Paediatric intracranial dural arteriovenous shunts: types, clinical presentation and therapeutic management

Paediatric intracranial dural arteriovenous shunts have clinical presentations and evolutions, with angiographic characteristics that differ from those described in adults. We report our experience concerning their therapeutic management, emphasizing the relevance of early diagnosis and appropriate...

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Autores principales: Smajda, Stanislas J., Söderman, Michael, Dorfmüller, Georg, Dorison, Nathalie, Nghe, Marie-Claire, Rodesch, Georges L.
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Oxford University Press 2022
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8889109/
https://www.ncbi.nlm.nih.gov/pubmed/35243346
http://dx.doi.org/10.1093/braincomms/fcac043
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author Smajda, Stanislas J.
Söderman, Michael
Dorfmüller, Georg
Dorison, Nathalie
Nghe, Marie-Claire
Rodesch, Georges L.
author_facet Smajda, Stanislas J.
Söderman, Michael
Dorfmüller, Georg
Dorison, Nathalie
Nghe, Marie-Claire
Rodesch, Georges L.
author_sort Smajda, Stanislas J.
collection PubMed
description Paediatric intracranial dural arteriovenous shunts have clinical presentations and evolutions, with angiographic characteristics that differ from those described in adults. We report our experience concerning their therapeutic management, emphasizing the relevance of early diagnosis and appropriate treatment for satisfactory neurocognitive development. Using a prospective database, we reviewed the clinical and radiological data of all children with dural arteriovenous shunts managed between 2002 and 2020. Dural shunts were categorized into three types: dural sinus malformations with arteriovenous shunts; infantile dural arteriovenous shunts; and adult-type dural arteriovenous shunts. Therapeutic strategies and outcomes were analysed depending on lesional subtypes. Modified Rankin Scale for the paediatric population was assessed pre-treatment and at last follow-up. Twenty-eight patients [16 girls (57.1%); 12 boys (42.9%)] were included: 17 dural sinus malformation [10 boys (58.8%); seven girls (41.2%)], three infantile shunts [three girls (100%)], eight adult-type shunts [four girls (50%)]; four boys (50%)], with a mean age of 19.2 ± 36.6 months at presentation. Twelve (42.9%) had a modified Rankin Scale score of 0–2, four (14.3%) had a score of 3, three (10.7%) had a score of 4 and eight (28.6%) had a score of 5. Embolization was performed in 22 children [78.6%; 12 girls (54.5%); 10 boys (45.5%)]. Fifteen patients could be cured (68.2%): 11 dural sinus malformations (73.3%), four adult-type lesions (100%) but no infantile shunt. Mean post-treatment follow-up was 39.5 months (max. 139 months): 14 patients (63.6%) presented a modified Rankin Scale score of 0–2 and eight (36.4%) had a score ≥3. In the dural sinus malformation group, the modified Rankin Scale score was improved in 11 patients (73.3%) and unchanged in three (20%). Only one patient with infantile subtype (33.3%) improved clinically. In the adult-subtype group, all children (100%) improved. Of six untreated patients [four girls (66.7%); two boys (33.3%)], four with adult-subtype shunts showed uneventful evolutions, one with dural sinus malformation died, and therapeutic abortion was conducted in an antenatally diagnosed dural sinus malformation. Paediatric dural fistulas comprise different subtypes with variable clinical courses. Proper diagnosis is mandatory for optimal therapeutic strategies within appropriate therapeutic windows.
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spelling pubmed-88891092022-03-02 Paediatric intracranial dural arteriovenous shunts: types, clinical presentation and therapeutic management Smajda, Stanislas J. Söderman, Michael Dorfmüller, Georg Dorison, Nathalie Nghe, Marie-Claire Rodesch, Georges L. Brain Commun Original Article Paediatric intracranial dural arteriovenous shunts have clinical presentations and evolutions, with angiographic characteristics that differ from those described in adults. We report our experience concerning their therapeutic management, emphasizing the relevance of early diagnosis and appropriate treatment for satisfactory neurocognitive development. Using a prospective database, we reviewed the clinical and radiological data of all children with dural arteriovenous shunts managed between 2002 and 2020. Dural shunts were categorized into three types: dural sinus malformations with arteriovenous shunts; infantile dural arteriovenous shunts; and adult-type dural arteriovenous shunts. Therapeutic strategies and outcomes were analysed depending on lesional subtypes. Modified Rankin Scale for the paediatric population was assessed pre-treatment and at last follow-up. Twenty-eight patients [16 girls (57.1%); 12 boys (42.9%)] were included: 17 dural sinus malformation [10 boys (58.8%); seven girls (41.2%)], three infantile shunts [three girls (100%)], eight adult-type shunts [four girls (50%)]; four boys (50%)], with a mean age of 19.2 ± 36.6 months at presentation. Twelve (42.9%) had a modified Rankin Scale score of 0–2, four (14.3%) had a score of 3, three (10.7%) had a score of 4 and eight (28.6%) had a score of 5. Embolization was performed in 22 children [78.6%; 12 girls (54.5%); 10 boys (45.5%)]. Fifteen patients could be cured (68.2%): 11 dural sinus malformations (73.3%), four adult-type lesions (100%) but no infantile shunt. Mean post-treatment follow-up was 39.5 months (max. 139 months): 14 patients (63.6%) presented a modified Rankin Scale score of 0–2 and eight (36.4%) had a score ≥3. In the dural sinus malformation group, the modified Rankin Scale score was improved in 11 patients (73.3%) and unchanged in three (20%). Only one patient with infantile subtype (33.3%) improved clinically. In the adult-subtype group, all children (100%) improved. Of six untreated patients [four girls (66.7%); two boys (33.3%)], four with adult-subtype shunts showed uneventful evolutions, one with dural sinus malformation died, and therapeutic abortion was conducted in an antenatally diagnosed dural sinus malformation. Paediatric dural fistulas comprise different subtypes with variable clinical courses. Proper diagnosis is mandatory for optimal therapeutic strategies within appropriate therapeutic windows. Oxford University Press 2022-02-23 /pmc/articles/PMC8889109/ /pubmed/35243346 http://dx.doi.org/10.1093/braincomms/fcac043 Text en © The Author(s) 2022. Published by Oxford University Press on behalf of the Guarantors of Brain. https://creativecommons.org/licenses/by-nc/4.0/This is an Open Access article distributed under the terms of the Creative Commons Attribution-NonCommercial License (https://creativecommons.org/licenses/by-nc/4.0/), which permits non-commercial re-use, distribution, and reproduction in any medium, provided the original work is properly cited. For commercial re-use, please contact journals.permissions@oup.com
spellingShingle Original Article
Smajda, Stanislas J.
Söderman, Michael
Dorfmüller, Georg
Dorison, Nathalie
Nghe, Marie-Claire
Rodesch, Georges L.
Paediatric intracranial dural arteriovenous shunts: types, clinical presentation and therapeutic management
title Paediatric intracranial dural arteriovenous shunts: types, clinical presentation and therapeutic management
title_full Paediatric intracranial dural arteriovenous shunts: types, clinical presentation and therapeutic management
title_fullStr Paediatric intracranial dural arteriovenous shunts: types, clinical presentation and therapeutic management
title_full_unstemmed Paediatric intracranial dural arteriovenous shunts: types, clinical presentation and therapeutic management
title_short Paediatric intracranial dural arteriovenous shunts: types, clinical presentation and therapeutic management
title_sort paediatric intracranial dural arteriovenous shunts: types, clinical presentation and therapeutic management
topic Original Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8889109/
https://www.ncbi.nlm.nih.gov/pubmed/35243346
http://dx.doi.org/10.1093/braincomms/fcac043
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