Fistula dural tipo adulta en un lactante: Reporte del caso y revisión de la bibliografía / Adult type dural A-V fistula in an infant: Report of a case and bibliographical review

Introduction. Dural arteriovenous malformations are rare in children. They constitute a group of entities with different origin, pathophysiology and prognosis. Case report. A 9 month old infant was brought to consultation because of cranial bruit in the left retroauricular area and opisthotonus crisis. CAT scan of the brain showed modest enlargement of ventricles and widening of the subarachnoid space. Cerebral angiography depicted an adult type dural arteriovenous fistula and thrombosis of the left transverse sinus. Angiographic cure was achieved by transarterial embolization of the fistula. The clinical condition of the patient improved significantly. Discussion. Dural arteriovenous fistulae (DAVS) constitute an heterogeneous group of disorders with an overall mortality of 38%. They have been classified by Lasjaunias in three categories: 1- Dural sinus malformations with DAVS, 2- Infantile type DAVS, and 3- Adult type DAVS. Clinical manifestations depend on the extent of the disorder and the magnitude of venous hypertension. Neonates may present with congestive heart failure (CHF). Infants and older children often show cranial bruits associated with macrocrania, seizures and developmental delay of variable severity. Conclussion. DAVS are unusual in the pediatric population. Early diagnosis and treatment are of major importance, in order to control venous hypertension and avoid the development of irreversible brain damage. Endovascular therapy has an important role in the acute treatment of CHF, and seems to be the best choice for treatment, either curative or palliative.

Tercer ventriculostomía endoscópica: mecanismos de fracaso y consideraciones sobre re fenestración o colocación de shunt / Endoscopic III ventriculostomy: Mechanisms of failure and considerations about refenestration of shuting

Objective: To evaluate retrospectively, a group of patients of our series, that had a failed ventriculostomy to try to determine the causes and the treatement offered to them. Material and method: 140 ETVs were performed in 132 patients; 120 of them are shunt free (90.90). Eight patients (5.71) showed closure of the ventriculostomy: in 4, it was presumed to be related to postoperative radiotherapy; 2 patients had an insufficient opening of the Lilliequist membrane and 2 showed ostoma closure of origin. In all of them a second ETV was performed, and the procedure was successful. Twelve patients (8.57) required shunt placement; 4, with a history of septated postmeningitis hydrocephalus, now only need a single ventricular catheter. Of the remaining, 3 presented with meningeal seeding from malignant tumors; 1 with racemous neurocysticerosis, 1 with multiple malformations and history meningitis; 2 with a previously unknown aresorptive component; 1 with history of post- shunt meningitis. Most patients with ETV failure developed CSF fistula. In all these cases, patency of the ostoma was confirmed during re-exploration, and consequently, a shunt was indicated. Discussion and conclusion: We consider ETV to be the standard treatment for obstructive hydrocephalus. With low morbidity in our series (4.68) and no mortality. Re-exploration and eventual re-fenestration are indicated in al cases of ETV failure, given the benefits of shunt independence.