Tips for Managing DAVFs in Children – Drs Ramon Navarro and Gary Steinberg

 

  • DAVF diagnosis: Due to their extremely low prevalence, high suspicion is essential in order to diagnose DAVFs in children.
  • Diagnostics: A complete cerebral angiogram (bilateral carotids including external carotid artery, bilateral vertebral arteries) is the gold standard for diagnosis and treatment planning.
  • Hypercoagulable states: Rule out hypercoagulable states and treat them if present.
  • Prompt treatment: Prompt treatment is advised in the presence of cortical venous drainage or if cases with hemorrhagic presentation.
  • Treatment modalities: These include neuro-interventional procedures, open surgery and radiosurgery or a combination of all these. In general, endovascular techniques are favored.
  • Multidisciplinary team: A multidisciplinary team should deal with children harboring DAVFs. Do not hesitate to contact your adult interventional and vascular neurosurgery colleagues.
  • Open surgical approach: This is aimed to disconnect the venous drainage from the malformation feeders. This can be confirmed with intraoperative angiogram, ICG angiography and intraoperative Doppler.
  • Follow-up: Patient follow-up is essential as these lesions are known to recur.