Encephaloduroarteriosynangiosis for the Treatment of Cerebral Arteriovenous Malformations in the Pediatric Population

Arteriovenous malformations (AVMs) in the pediatric population are rare but represent a critical cause of spontaneous intracranial hemorrhage. Here we present the case of an 11-year-old boy who developed acute-onset left-sided weakness, slurred speech, and transient hemiparesis. While initial laboratory findings were unremarkable, brain magnetic resonance imaging revealed a large right cerebral AVM. Cerebral angiography confirmed this finding, showing a Spetzler-Martin grade V AVM, supplied by the middle, anterior, and posterior cerebral arteries. The patient was treated using a multimodal approach, including embolization and encephaloduroarteriosynangiosis (EDAS). Postoperatively, he experienced transient worsening of hemiparesis of unknown etiology, which gradually improved. Long-term follow-up demonstrated improved motor function with persistent mild left-sided weakness. This case highlights the significance of multimodal management in high-grade pediatric AVMs. This particular includes the utility of EDAS, originally developed for moyamoya disease, in mitigating ischemia by promoting collateral neovascularization and thus improving neurological symptoms.