An incidental pure arterial malformation in a child: case report and review of the literature
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CASE REPORT
An incidental pure arterial malformation in a child: case report and review of the literature Meena Thatikunta 1 & Natasha V. Raman 1 & Kristin N. Zieles 1 & Katrina Ducis 1 & Andrew Jea 1 Received: 8 January 2020 / Accepted: 8 February 2020 # Springer-Verlag GmbH Germany, part of Springer Nature 2020
Abstract Purpose Pure arterial malformations of the brain are rare vascular lesions. Methods We present a 10-year-old healthy boy who presented with an incidental finding of pure arterial malformation. Results Our case seems to represent the second description of pure arterial malformation discovered incidentally in a child. Conclusion We review the clinical presentation, angiographic findings, and management of our case in the context of other reported pediatric cases. Keywords Arterial malformation . Angiography . Pediatric neurosurgery . Endovascular
Introduction Recently, greater attention has been garnered on rare vascular malformations of the brain —“pure arterial malformations”— in both the adult and pediatric age groups [1–9]. Moreover, pure arterial malformations are thought to be associated with a benign natural history and should be treated conservatively. At times, these malformations may be mistaken for arteriovenous malformations (AVMs), arteriovenous fistulas (AVFs), or cerebral saccular aneurysms [2–5].
* Andrew Jea [email protected] Meena Thatikunta [email protected] Natasha V. Raman [email protected] Kristin N. Zieles [email protected] Katrina Ducis [email protected] 1
Section of Pediatric Neurosurgery, Department of Neurological Surgery, Riley Hospital for Children, Indiana University School of Medicine, 705 Riley Hospital Drive, Suite 1601, Indianapolis, IN 46202, USA
Incidental presentation of pure arterial malformation in otherwise healthy children has been less frequently described [9]. In this study, we describe the clinical course of one child over 12 months of follow-up.
Case report History Our patient is a 10-year-old boy who presented after a concussion suffered during a hockey game. He had no relevant past medical history. A noncontrast CT of the head (Fig. 1) suggests abnormal cerebral vasculature. The patient was otherwise asymptomatic.
Examination Patient displayed a normal neurological examination without focal deficits. There was no pronator drift.
Diagnostic studies Advanced imaging with CT angiogram (CTA) of the head (Fig. 2) revealed a tortuosity of vessels in the left internal carotid artery segments. Patient then underwent a diagnostic cerebral angiogram (Fig. 3). There was no aneurysm, AV
Childs Nerv Syst Fig. 1 CT head. a Coronal and b axial noncontrast head CT shows a hyperdense mass with eggshell calcifications in the region of the supraclinoidal segments of the internal carotid artery, suggestive of a vascular malformation
fistula, or early venous phase drainage associated with this malformation.
Clinical course The patient did well throughout the year of follow-up and at 1 year after the procedure. He remained asymptomatic. There was
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