A 16-month-old female was admitted for prolonged fever, gait ataxia, and neurogenic bowel and bladder. Neurological exam was significant for decreased sensory and motor functions in bilateral lower extremities. Initial MRI showed a thoracic spine hematoma and diagnostic angiogram revealed a large AVM and aneurysm. The patient underwent surgical resection of the hematoma and AVM, as well as clipping and later endovascular coiling of the aneurysm. Due to significant hemorrhage perioperatively, she developed spastic paraplegia improved by baclofen and onabotulinumtoxin A injections. The aims of this paper were to conduct a systematic review of the literature on pediatric spinal cord vascular malformations and analyze trends in treatment options and long-term neurological outcomes. PubMed searches were conducted using keywords "pediatric spinal vascular malformation" and "pediatric spinal AVM", yielding 34 results after abstract screening and cross-reference. Endovascular embolization was determined to have better long-term outcomes, with 10/19 (52.6%) patients with postoperative complications associated with open vascular surgeries. Open versus endovascular surgical decisions can be difficult with unique spinal AVM pathologies in pediatric patients. Important considerations such as size, location, neurological deficits, and risk of rupture are important factors to consider in treating these patients. We recommend endovascular treatment as a first-line approach due to lower risk of hemorrhage and postoperative deficits.

中文翻译：

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小儿脊髓血管畸形的治疗选择和长期结局：1例病例并文献复习。

一名16个月大的女性因长时间发烧，步态共济失调以及神经源性肠和膀胱而入院。神经系统检查对于双侧下肢的感觉和运动功能下降很重要。最初的MRI显示胸椎血肿，诊断性血管造影显示大的AVM和动脉瘤。该患者接受了手术切除血肿和AVM的手术，并进行了夹闭术，随后进行了血管瘤的血管内盘绕。由于围手术期大量出血，她通过注射巴氯芬和肉毒杆菌毒素A改善了痉挛性截瘫。本文的目的是对有关小儿脊髓血管畸形的文献进行系统的综述，并分析治疗方案和长期神经系统结局的趋势。PubMed搜索使用关键字“ 血管内栓塞被确定具有较好的长期预后，有10/19（52.6％）例患者发生与开放性血管手术相关的术后并发症。在儿科患者中，独特的脊柱AVM病理对开放或血管内手术决策可能很困难。重要的考虑因素如大小，位置，神经功能缺损和破裂风险是治疗这些患者的重要因素。我们建议将血管内治疗作为一线治疗方法，因为这样可以降低出血和术后不足的风险。血管内栓塞被确定具有较好的长期预后，有10/19（52.6％）例患者发生与开放性血管手术相关的术后并发症。在儿科患者中，采用独特的脊柱AVM病理可能很难进行开放手术还是血管内手术决策。重要的考虑因素如大小，位置，神经功能缺损和破裂风险是治疗这些患者的重要因素。我们建议将血管内治疗作为一线方法，因为这样可以降低出血和术后不足的风险。重要的考虑因素如大小，位置，神经功能缺损和破裂风险是治疗这些患者的重要因素。我们建议将血管内治疗作为一线治疗方法，因为这样可以降低出血和术后不足的风险。重要的考虑因素如大小，位置，神经功能缺损和破裂风险是治疗这些患者的重要因素。我们建议将血管内治疗作为一线治疗方法，因为这样可以降低出血和术后不足的风险。