Angiomatous and fistulous arteriovenous aneurysm in children: with comments on the opportunity and results of treatment in 27 cases

Abstract

It is the purpose of this communication to offer some comments on the type, location and surgical results in 27 arteriovenous aneurysms admitted to the Buenos Aires Children's Hospital during the last 10 years. Ligation of the afferent artery in fistulous arteriovenous aneurysms is a rather simple and successful procedure. Occlusion of the afferent artery was carried out successfully in six out of seven cases, intracranially in two, extracranially in four. A Torkildsen procedure was employed as already mentioned in one case with a bilateral fistula of the posterior cerebral arteries into the vein of Galen. Fistulous arteriovenous aneurysms are much more frequent in children than in adults and can be easily and successfully treated by ligation of afferent arteries. Only one half of the angiomatous arteriovenous aneurysms in children are amenable to radical surgical removal. Intracranial bleeding due to cirsoid aneurysms with early deepening coma and decerebrate rigidity requires extremely urgent arteriography and surgical treatment. The results of radical surgery within the first 12 h are in such cases highly rewarding. Hydrocephalus due to aqueduct stenosis in lesions involving the brain stem can improve with ventriculocisternostomy. Ventriculovenous shunts are contraindicated in these cases.