Arteriovenous Malformations in the Pediatric Population: Review of the Existing Literature

Abstract

Arteriovenous malformations (AVMs) in the pediatric population are relatively rare but reportedly carry a higher rate of rupture than in adults. This could be due to the fact that most pediatric AVMs are only detected after rupture. We aimed to review the current literature regarding the natural history and the clinical outcome after multimodality AVM treatment in the pediatric population, as optimal management for pediatric AVMs remains controversial. A multidisciplinary approach using multimodality therapy if needed has been proved to be beneficial in approaching these lesions in all age groups. Microsurgical resection remains the gold standard for the treatment of all accessible pediatric AVMs. Embolization and radiosurgery should be considered as an adjunctive therapy. Embolization provides a useful adjunct therapy to microsurgery by preventing significant blood loss and to radiosurgery by decreasing the volume of the AVM. Radiosurgery has been described to provide an alternative treatment approach in certain circumstances either as a primary or adjuvant therapy.

European consensus conference on unruptured brain AVMs treatment (Supported by EANS, ESMINT, EGKS, and SINCH)

“…In the survey, younger age was not considered a reason to withhold treatment by all the participants and surgery was suggested by 85% of the panel [9,28,32].…”

Pediatric intracranial arteriovenous malformations: a single-center experience

“…23 If the AVM is only partially obliterated with radiosurgery, studies have suggested that the rupture risk may be similar to the natural history of 2.6% per year. 8 Additionally, in ARUBA (A Randomized Trial of Unruptured Brain Arteriovenous Malformations), which compared the risk of death and symptomatic stroke in adult patients with unruptured cerebral AVMs randomly assigned to medical management or medical management plus intervention, including neurosurgical, endovascular, or radiotherapy procedures, researchers found a significantly lower risk of death and neurological disability at 30 months' follow-up in the medical management group (15.1% vs 46.2%). 19 While the ARUBA findings are not generalizable to pediatric populations, based on an extrapolation of its findings and for the reasons aforementioned, we propose serial surveillance as a viable option in patients with high-grade unresectable lesions.…”

Successful Treatment of a Child with Ruptured Arteriovenous Malformation Using Onyx Embolization: A Case Report

“…Arteriovenous Malformations (AVMs) refers to anomalous proliferation or collection of dilated arteries and veins within the brain parenchyma with an anomalous superseding capillary bed, instigating shunting [1] [2] [3]. The occurrences of cerebral AVMs are uncommon in pediatric age group, although they are believed to be congenital [3] [4].…”

“…The occurrences of cerebral AVMs are uncommon in pediatric age group, although they are believed to be congenital [3] [4]. In children, AVMs can manifest as spontaneous hemorrhage resulting in hydrocephalus, non-specific headaches, epilepsy or focal neurological deficit [5].…”

“…Therefore, complete or proximately complete obliteration of the feeding vessels as well as vascular nidus is required. Coil embolization of the AVM followed by surgical resection or radio surgery was the ultimate treatment modalities although complete obliteration of the nidus via embolization was not possible in most cases [3] [6] [7] [8]…”