Zagorodnij V. Endovascular treatment of arteriovenous malformations in children.

The thesis is devoted to endovascular treatment of cerebral arteriovenous malformations (AVM) in children. The research is based on analysis of results of complex examination and treatment of 67 children, been operated using endovascular techniques in SI "Scientific-practical Center of endovascular neuroradiology of NAMS of Ukraine" in the period from 1981 to 2010. The obtained results let us to identify features of clinical flow of cerebral vessels AVM in children, depending on their location and size. Most often malformations in childhood are shown up by intracranial hemorrhages (74.6% cases). It was established that medium and large sizes malformations of subcortical and functionally important brain regions are most characteristic for children. Main diagnostic method to set indications for cerebral vessels AVM endovascular shutdown in children is selective cerebral angiography. Cerebral angiography allows to identify malformation's location, size, type of structure (fistula, cavernous, mixed), afferent vessels, their functional significance, and drainage system condition. Thus, cerebral angiography should be conducted in all children with suspicion on AVM. On the base of study of different endovascular techniques features depending on AVM architectonics peculiarities indications for AVM endovascular treatment in children were developed: in case of expressed direct arteriovenous shunt detachable balloons, catheters and coils were most effective for afferent artery occlusion; in case of expressed arterial shunt absence liquid or solid embolization substances should be used that allows to attain AVM niduce complete shutdown. Using endovascular treatment method in children with cerebral AVM total malformation's shutdown was achieved in 28.4% patients, subtotal - in 43.3%, partial - in 14.9%, angiomatosis was observed in 10.4% cases. It is established that results of AVM shutdown depend on their size and type of blood supply. Best results were observed at small and medium-sized malformations - their total shutdown was achieved in 54.6 and 44% cases, respectively. At fistula malformations total shutdown was achieved in 66.6% children. Localization of AVM and it's drainage system structure do not influence on results of malformation's shutdown in children. This again confirms the fact that due to modern techniques of cerebral AVM endovascular shutdown in children, the localization of process plays secondary role. Main results of the research were introduced into clinical practice of SI "Scientific-practical Сenter of endovascular neuroradiology of NAMS of Ukraine".