Pediatric dural arteriovenous malformations (dAVMs) are rare lesions that have a high mortality rate and require complex management. The authors report 3 cases of pediatric dAVMs that presented with macrocrania and extracranial venous distension. Dural sinus thrombosis developed in 2 of the cases prior to any intervention, which is an unusual occurrence for this particular disease. All 3 cases were treated using staged endovascular embolization with a favorable outcome in 1 case and a poor outcome in the other 2 cases. Complications developed in all cases and included dural sinus thrombosis, parenchymal hemorrhage, intracranial venous hypertension, and seizures. The strategies and challenges used in managing these patients will be presented and discussed, along with a review of the literature. While outcomes remain poor, the authors conclude that prompt treatment with endovascular embolization provides the best results for children with these lesions. A well-established venous collateral circulation draining directly to the internal jugular veins may further improve the rate of favorable outcome after embolization.
Keywords: DSA = digital subtraction angiography; ECA = external carotid artery; ICA = internal carotid artery; IJV = internal jugular vein; IOP = intraocular pressure; MMA = middle meningeal artery; OA = occipital artery; dAVM = dural arteriovenous malformation; dAVS = dural arteriovenous shunt; dural arteriovenous malformation; endovascular embolization; sinus thrombosis; vascular disorders.