Vascular malformations of the brain venous system in children.

The vascular malformations of the central nervous system are an important cause of venous strokes in children. Arteriovenous malformations are characterized by direct anastomosis of arterial and venous channels without an intervening capillary bed. Vein of Galen malformation and cavernous malformation are a rare but important causes of mortality in neonates and infants. In our study of 22 children (males and females of 5-15 years of old) with cerebral venous system pathology, only in one case we diagnosed the VGAM and in two cases cavernous malformation. Doppler ultrasound is critical for the prenatal diagnosis of VGAM, and shows an intracerebral hypoechoic cyst. MRI and MRA usually confirm the diagnosis. MRI is mandatory before treatment to assess the condition of the brain parenchyma, while conventional angiography is essential for pretreatment evaluation. Awareness of these potential causes of venous stroke, early diagnosis, and appropriate therapeutic strategies are paramount to reduce mortality and improve neurologic outcome in the pediatric population.