Ho-ho-ho! Gather ’round, my little elves, for I have a tale or two to share from the wondrous and intricate world of pediatric medicine, where the brain and spine are the playgrounds for some rather mischievous arteriovenous shunts. Now, these aren’t your typical toys from Santa’s workshop; they’re quite rare and can be as unpredictable as a reindeer on a roof!

In our first story, we have a tiny infant, who had previously faced the storm of an intracranial hemorrhage due to a ruptured pial fistula. This little one was all set for an elective embolization to fix a second pial fistula, but by jingle bells, it had spontaneously thrombosed—that’s doctor-speak for clogged up on its own—just two weeks later!

Moving on to our second tale, a 5-year-old child, who was as curious as an elf in a toy factory, was found to have a vertebro-vertebral fistula. This was quite the discovery during a check-up for a heart murmur. The child was scheduled for an elective embolization six weeks later, but lo and behold, spontaneous thrombosis had occurred once again!

Now, my dear friends, after delving into the literature like checking the list twice, the authors have come up with some morphologic considerations. These are like little clues to help determine which high-flow fistulae might just resolve on their own, like a snowflake melting away. This could help avoid the unnecessary risks of interventions in our precious little ones.

So, as we wrap up this narrative like a present under the tree, remember that in the magical realm of pediatric pial arteriovenous shunts, sometimes nature has its own way of sorting things out, much like how I decide who’s naughty or nice. Merry reading, and may your days be merry and bright with knowledge! 🎅🎄