Multimodal Treatment of Pediatric Ruptured Brain Arteriovenous Malformations: A Single-Center Study

Abstract

Bleeding from ruptured brain arteriovenous malformations (bAVMs) represents the most prevalent cause of pediatric intracranial hemorrhage, being also the most common initial bAVM manifestation. A therapeutic approach in these patients should aim at preventing rebleeding and associated significant morbidity and mortality. The purpose of this study was to determine the clinical outcomes of pediatric patients who initially presented at our institution with ruptured bAVMs and to review our experience with a multimodality approach in the management of pediatric ruptured bAVMs. We retrospectively reviewed pediatric patients’ medical records with ruptured bAVMs who underwent interventional treatment (microsurgery, embolization, or radiosurgery; solely or in combination) at our institution between 2011 and 2020. We identified 22 patients. There was no intraoperative and postoperative intervention-related mortality. Neither procedure-related complications nor rebleeding were observed after interventional treatment. Modified Rankin Scale (mRS) assessment at discharge revealed 19 patients (86.4%) with favorable outcomes (mRS 0–2) and 3 patients (13.6%) classified as disabled (mRS 3). Microsurgery ensured the complete obliteration in all patients whose postoperative digital subtraction angiography (DSA) was available. Management of high-grade bAVMs with radiosurgery or embolization can provide satisfactory outcomes without a high disability risk.

Intraoperative Monitoring Cerebral Blood Flow During the Treatment of Brain Arteriovenous Malformations in Hybrid Operating Room by Laser Speckle Contrast Imaging

“…The treatment of complex brain arteriovenous malformations (bAVM) remains a challenge for neurosurgeons (1,2). In the past decades, we have learned more about the anatomy of bAVM and made a great advance in therapy (2)(3)(4)(5). Complete nidus obliteration is the only therapeutic treatment, while partial resection is neither efficacious nor prevents recurring bleeding (5)(6)(7)(8)(9)(10).…”

Introduction to the Special Issue on Ischemic Stroke in Children

“…In the second original research, Antkowiak et al [ 5 ] analyzed the clinical outcomes of 22 pediatric patients (mean age 11.9 years) who initially presented ruptured brain arteriovenous malformations (bAVMs). No procedural complications or re-bleeding were observed after interventional treatment.…”

“…Overall, 19 patients (i.e., over 86%) showed good results on the modified Rankin scale (mRS 0–2) at discharge, while 3 patients (i.e., almost 14%) were classified as disabled (mRS 3). According to authors, the use of radiosurgery or embolization in the management of high-grade bAVMs may provide satisfactory results without a high risk of disability [ 5 ].…”