Intracranial arteriovenous anomalies of infancy: modern concepts.

A variety of cerebrovascular abnormalities may become manifest in the first years of life. We present our recent experience with 7 children, ages 1 week to 7 months of age, who presented with congestive heart failure and progressive head enlargement (3), heart failure alone (1) and head enlargement alone (2). The anomalies include vein of Galen aneurysm (3), complex arteriovenous fistula (2) and posterior fossa dural arteriovenous malformations (2). Computed tomographic scanning was invaluable in delineating the site of the lesion while arterial digital subtraction angiography was utilized to obtain the high-quality images, reduced dye volume and rapid filming. Direct surgical intervention was accomplished in 5 cases, while embolization was utilized in 2. One child underwent direct partial occlusion and embolization. Congestive heart failure resolved in 2 of 3 operated cases and improved in those undergoing embolization. Hydrocephalus improved in 2 cases with the elimination of the fistula. Morbidity included seizures and a hemorrhagic infarction in 1 case. Neurologic outcome was satisfactory and there was no surgical mortality.