Clinical, radiological profile and outcome in pediatric Spetzler–Martin grades I–III arteriovenous malformations

Nair, Anup; Kumar, Raj; Mehrotra, Anant; Srivastava, Anshu; Sahu, Rabi Narayan; Nair, Prakash

doi:10.1007/s00381-011-1668-6

Cited by 29 publications

(19 citation statements)

References 27 publications

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“…11,13,16 No deaths were recorded in our series, nor were any long-term new neurological deficits, although 2 patients had transient contralateral weakness immediately postoperatively. This rate of good functional outcome is similar to that noted by Nair et al, 16 who found that 86% of patients had a favorable outcome (mRS Score ≤ 2).…”

Section: Discussionmentioning

confidence: 68%

“…16 Recent technological advances now allow multimodality treatments of an AVM including microsurgical, endovascular, and stereotactic interventions. Overall, mortality from pediatric AVM has reduced to around 4.5%-12% depending on lesion location.…”

Section: Discussionmentioning

confidence: 99%

“…1,14,22 Intraoperative angiography and indocyanine green video-angiography have also been used in conjunction with intraoperative Doppler ultrasound to aid AVM resection in the adult population. 2,19,27 Several authors have reported the use of multimodality treatment in the pediatric population, 3,5,9,11,13,16,17,19,25 including neuronavigation, ultrasound, or intraoperative angiography. Complete resection rates are all high in the published series, ranging from 80% to 100%.…”

Section: Discussionmentioning

confidence: 99%

“…11,13,17,18 These lesions can be extremely challenging to manage given the higher incidence of hemorrhagic presentation and accompanying morbidity and mortality as well as the long potential lifespan of the pediatric patient. 13,[16][17][18] Arteriovenous malformations in the pediatric population have generally been associated with higher morbidity and mortality than those in adults, 11,18 although a recent study suggests that surgery may improve long-term outcomes. 21 There is also a well-described phenomenon of AVM recurrence following negative postresection angiography in the pediatric population.…”

mentioning

confidence: 99%

“…7,11,18 Nonetheless, pediatric AVMs have been treated surgically, with endovascular embolization, with radiosurgery, and increasingly with multimodality treatments with good results. 5,[16][17][18] The neurosurgical application of intraoperative ultraabbreviatioNs AVM = arteriovenous malformation; DSA = digital subtraction angiography; GCS = Glasgow Coma Scale; MCA = middle cerebral artery; mRS = modified Rankin Scale; SM = Spetzler-Martin. results All patients, whose ages ranged from 2 to 16 years, underwent craniotomy and excision of an AVM, which was supratentorial in 18 cases and infratentorial in 2.…”

mentioning

confidence: 99%

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Use of intraoperative Doppler ultrasound with neuronavigation to guide arteriovenous malformation resection: a pediatric case series

Walkden¹,

Zádor²,

Herwadkar³

et al. 2015

PED

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OBJECT Over the last 20 years, several intraoperative adjuncts, including ultrasonography, neuronavigation, and angiography, have been said to aid the intraoperative localization and resection of cerebral arteriovenous malformations (AVMs). The authors assessed the value of intraoperative Doppler ultrasonography in conjunction with neuronavigation during surgery for cerebral AVMs in the pediatric population. METHODS The authors reviewed all cranial AVM resections performed by a single surgeon at their institution in the period from 2007 to 2013 and here describe their experience and results in a series of 20 consecutive AVM resections in 19 pediatric patients. Intraoperative Doppler ultrasonography had been used in conjunction with preoperative CT or neuronavigational MRI. Preoperative and postoperative clinical findings, patient age, and Spetzler-Martin AVM grade were identified in all patients. RESULTS All patients, whose ages ranged from 2 to 16 years, underwent craniotomy and excision of an AVM, which was supratentorial in 18 cases and infratentorial in 2. Patients in 11 cases underwent preoperative embolization, and all other patients underwent cerebral angiography prior to surgery, except for 2 patients who were urgently surgically treated because of low Glasgow Coma Scale scores and associated hematoma. Spetzler-Martin Grades I (3 cases), II (6), III (7), and IV (4) AVMs were represented in this series. Intraoperative Doppler ultrasound provided high-quality images in all cases and demonstrated the location, size, and flow characteristics of the AVM and any associated hematoma. Delayed postoperative cerebral angiography demonstrated successful AVM resection in all cases. An assessment of clinical outcomes revealed no new long-term neurological deficits at 3 months postoperatively. CONCLUSIONS Intraoperative Doppler ultrasonography is a reliable and useful tool for intraoperative localization and guidance for AVM resection in the pediatric population. When used in conjunction with neuronavigation equipment and modern microscopes, this technique has shown a very high complete resection rate with extremely low associated morbidity.