Pediatric Vascular Anomalies

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