Endovascular embolization for pediatric cerebral arteriovenous malformations

Arteriovenous malformations (AVMs) of the central nervous system (CNS) have a higher rupture rate and are a major cause of spontaneous intracranial hemorrhage in children compared to adults. Computed tomography angiography (CTA) is the gold standard diagnostic tool, and surgical excision remains the gold standard therapy, which can be used as an alternative diagnostic and therapeutic option for invisible AVM in pediatric patients. Here, we report the case of a ruptured pediatric AVM managed with endovascular embolization. A 9-year-old girl presented with the sudden onset of severe headache and right-sided weakness. While playing in a park, she suddenly developed severe throbbing headaches all over her head and was unable to lift right lower limb. However, the patient was conscious, oriented, and able to converse. Initial evaluation revealed right lower limb paresis and a FACES pain score of 6. Brain computed tomography (CT) revealed a large parietal intracerebral hemorrhage. The patient was treated with antiedema measures and analgesics. After stabilization, magnetic resonance angiography was performed, which raised the possibility of AVM. Digital subtraction angiography confirmed the diagnosis of ruptured left-sided parietal AVM. Endovascular embolization of the AVM was performed without any complications or sequelae. Transfemoral cerebral angiography is a better option for AVM because it provides diagnostic accuracy and treatment options in a single setting. With advances in interventional radiology, endovascular embolization offers a minimally invasive option for managing pediatric AVMs. This modality is particularly valuable in regions like the United Arab Emirates and MENA, where interventional radiology services remain limited, reducing the need for patients to seek care abroad.