Intracranial Arteriovenous Anomalies of Infancy: Modern Concepts

Godersky, John C.; Menezes, Arnold H.

doi:10.1159/000120337

Cited by 17 publications

(5 citation statements)

References 17 publications

(23 reference statements)

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“…The major feeder was the MCA, followed in declining order of frequency by ACA, PCA, PChA and AChA. Only 5 infants had posterior fossa AVMs, as in our case 2 [26,49,64,70]. Fistula-type AVMs were more common among neonates [15,18,19,27,28,64,76,80,82,85], whereas lesions presenting after the neonatal period were often plexiform AVMs.…”

Section: Arteriovenous Malformations In Infantsmentioning

confidence: 46%

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Spontaneous intracranial hemorrhage of structural origin during the first year of life

Tekkök

Ventureyra

1997

Child's Nervous System

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Symptomatic intracranial hemorrhage (ICH) in term infants is not common, but when it occurs it is usually secondary to trauma, coagulation disorders and/or hypoxia. The possibility of a structural cause for an infantile ICH is unfortunately not seriously considered until very late. In this paper we report the cases of five full-term infants, each of whom developed ICH secondary to a structural lesion during the 1st year of life. Three presented during the newborn period. A congenital saccular aneurysm of the middle cerebral artery in an 8-month old male infant; a posterior fossa arteriovenous malformation in a 2-week old female neonate; a deep parietal cavernous angioma in a 6.5-month-old male infant; a temporoparietal low-grade astrocytoma in a 12-day old male neonate and a temporoparietal desmoplastic ganglioglioma in a 9-day-old male neonate were the structural lesions that were causative for hemorrhage. In all cases but one, the diagnosis was reached by computerized tomography and/or magnetic resonance imaging. All infants underwent surgery for the removal of the hematoma and of the lesion causative for the bleed. All are alive at 19, 3, 11.5, 10, and 5 years, respectively. We discuss the diagnosis of ICH with special emphasis on contemporary imaging modalities and stress the benefits of aggressive and timely surgical treatment. We then consider a concise analysis of the world literature on the occurrence of structural causes of ICH during infancy.

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Section: Arteriovenous Malformations In Infantsmentioning

confidence: 46%

“…Seventy-five percent of all hemorrhage cases were in neonates. Hydrocephalus occurred in 16 (25%) of the infant cases [1, 26,47,49,50,59,64,82].…”

Section: Arteriovenous Malformations In Infantsmentioning

confidence: 99%

Spontaneous intracranial hemorrhage of structural origin during the first year of life

Tekkök

Ventureyra

1997

Child's Nervous System

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“…AVMs are considered to be of congenital origin [5] and most series note a common age of presentation at 20-40 years [15,24], Overall, an unruptured AVM has approxi mately a 2-4% risk of bleeding per year, and an approxi mate 1 % risk of death per year [4,8,25], In children, sei zures, aside from hemorrhage, are the second most com mon presenting symptom of AVMs [1][2][3][4]14], The esti mated risk of occurrence of seizures in patients with AVMs is 1.5% per person-year of observation [26], and the percentage of patients of all ages with AVMs who present with a seizure varies between 17 and 40% [27], In children with AVMs, the incidence varied from 11 to 40% [1][2][3], In the largest series of 132 patients, the incidence was 12% [14], In the present series, 18% of the children presented with seizures, and 21% had seizures as part of their clinical course.…”

Section: Discussionmentioning

confidence: 99%

Seizure Outcome in Children Treated for Arteriovenous Malformations Using Gamma Knife Radiosurgery

et al. 1996

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Seizures are the second most common presenting symptom of arteriovenous malformations (AVMs) in children. Although radiosurgery has been found to be a safe and effective alternateve treatment, the outcome of seizure control in children after radiosurgery for AVMs is unknown. Between 1987 and 1994, 72 children under the age of 18 years were treated with gamma knife radiosurgery for AVMs at our institution. Fifteen patients (21 %) had seizures as part of their clinical course. There were 11 boys and 4 girls with ages varying from 2 to 17 years (median 16 years). Seizures included: generalized tonic-clonic (n = 8); focal motor or sensory (n = 4); partial complex (n = 2), and a combination of generalized and partial complex (n = 1). Nine lesions were in cortical locations; six were subcortical. Spetzler-Martin grades included: II (n = 7); III (n = 4); IV (n = 2), and VI (n = 2). During follow-up after radiosurgical treatment, 11 of 13 patients (85%) were seizure free and off anticonvulsant therapy (mean follow-up 47 months). Two patients had a significant improvement in their seizures but continue on medication. Two of the 72 patients (3%) developed seizures after treatment and remain on medication. Seizure outcome was not associated with the location or complete obliteration of the lesion. We conclude that stereotactic radiosurgery, as a non-invasive alternative, is associated with a good outcome for the AVM as well as AVM-related seizures in children.

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“…Godersky et al reported successful embolization of a posterior fossa AVM in a six-month-old child suffering from congestive heart failure. 40 The patient had cardiac improvement without a surgical procedure. One patient in our series with an AVM of the pons (presenting with a cranial nerve palsy) was referred for stereotactic radiosurgery.…”

Section: Avm Management Strategiesmentioning

confidence: 93%

Arteriovenous Malformations of the Brain in Children: A Forty Year Experience

Kondziolka

et al. 1992

Can. j. neurol. sci.

193

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ABSTRACT:Despite the great capacity for the pediatric brain to recover from stroke, the morbidity and mortality in children who harbor an arteriovenous malformation (AVM) remains high. This study examines the clinical data and management experience with 132 patients with brain AVM from 1949 to 1989. Although the high tendency for a childhood AVM to present with hemorrhage (79%) remained constant for the forty year study period, the associated morbidity and mortality of hemorrhage changed. The mortality rate from hemorrhage for the entire series was 25%, which was reduced from 39% to 16% after the introduction of computed tomography. The mortality from AVM hemorrhage since 1975 was dependent on location; 8 of 14 patients (57%) with a cerebellar AVM died from hemorrhage while only 2 of 44 patients (4.5%) with a cerebral hemisphere AVM died (p < 0.0001). Sixteen children (12%) presented with a chronic seizure disorder. Surgical excision of the malformation resulted in complete seizure control off anti-convulsant medication in 73% of patients. Although 21% of patients were treated non-operatively (many with terminal poor-grade hemorrhage), 79% had a surgical procedure with total AVM excision achieved in 70 patients (53.1%). Complete AVM resection was followed by a normal neurological outcome in 47 children (67%). Most partial excisions (n=9) and clipping of feeding arteries (n=7) were performed in the early years of this study, and did not provide protection from rehe-morrhage. Although conservative management has been advocated for selected non-hemorrhagic AVMs, we conclude that essentially all children with an AVM should be treated in order to eliminate the risk of hemorrhage. Long-term conservative management in pediatric patients is warranted only in patients with large AVMs not amenable to treatment using current multimodality techniques.

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Intracranial Arteriovenous Anomalies of Infancy: Modern Concepts

Cited by 17 publications

References 17 publications

Spontaneous intracranial hemorrhage of structural origin during the first year of life

Spontaneous intracranial hemorrhage of structural origin during the first year of life

Seizure Outcome in Children Treated for Arteriovenous Malformations Using Gamma Knife Radiosurgery

Arteriovenous Malformations of the Brain in Children: A Forty Year Experience

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