Surgical treatment of infants with intracranial hemorrhages due to ruptured vascular malformation. Literature review

Abstract

The purpose of the study: to analyze the timing and types of treatment in infants diagnosed with intracranial hemorrhage (ICH) due to a ruptured vascular malformation. Materials and methods. The study included 4 infants with ICH; the causes of the hemorrhages were a rupture of arteriovenous malformation (AVM) in 2 (50 %) patients and arterial aneurysm (AA) in 2 (50 %) patients, aged less than one year. Hematoma evacuation was performed in 4 (100 %) patients. Microsurgical clipping and removal of the aneurysm was performed in 2 (50 %) patients, and total endovascular embolization was performed in 2 (50 %) patients. After surgical treatment, there were no fatal cases. Post-stroke epilepsy developed in 2 (50 %) patients who subsequently underwent functional peri-insular hemispherotomy, as a result of which the seizures were stopped completely. Posthemorrhagic hydrocephalus was observed in 1 (25 %) patient, who later underwent ventriculoperitoneal shunting. The article discusses the features of diagnostics and treatment tactics of children with vascular malformations in the acute and subacute periods of intracranial hemorrhage (ICH). Results. Complete disconnection of the vascular malformations from the cerebral circulation was successful in all cases. Conclusion. When intracerebral hematoma in infants is confirmed, vascular intracranial pathology must be ruled out first, and an individualized treatment approach for each patient is necessary. Patients diagnosed with a ruptured cerebral AVM should be treated as quickly as possible in a specialized pediatric stroke center.