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Pediatric Vascular Anomalies

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VASCULAR ANOMALIES

Arterio-Venous Malformation (AVM)

  • Angiogram necessary
  • Treatment is:
    • Surgery
    • Gamma Knife
    • Embolization
  • 1%/yr risk of hemorrhage
  • 50% mortality with hemorrhage


 

Spetzler Martin AVM Operative Risk Grading System

Risk Factors:

Size:

<3cm                   1

3 to 6 cm              2

over 6 cm             3

 

Position: 

silent                    0

eloquent               1

 

Veins:

superficial            0

deep                     1

 

VASCULAR ANOMALIES

Arterio-Venous Fistula

  • Angiogram necessary
  • Treatment is
    • Surgery
    • Embolization
  • Often caused by trauma

Cavernous Hemangioma

  • MRI necessary
  • Usually angiographically absent
  • Low flow
  • Low risk of hemorrhage
    • Treatment is dependent on symptoms(hemorrhage, head-aches, seizures)

Venous Angioma

  • MRI necessary
  • Low flow
  • No risk of hemorrhage
    • Treatment will cause a stroke (no treatment is given)

Carotid stenosis(Moya Moya)

  • More common in the sickle cell patient population
  • High risk of stroke (80% at 2 years)
  • Medical treatment with transfusion reduces stroke rate in sickle cell patient  population
  • Surgical management
    • EC-IC bypass
    • Pial synangiosis