Pediatric arteriovenous malformations: a 15-year experience with an emphasis on residual and recurrent lesions

Abstract

Most pediatric AVMs can be successfully treated with microsurgical resection. Endovascular treatment is reserved primarily as a preoperative adjunct and stereotactic radiosurgery for inoperable AVMs. Patients may develop recurrences years after their original treatment. Patients with diffuse-type AVMs were less likely to be cured and more likely to have a residual or a recurrence.

Recurrent Cerebral Arteriovenous Malformation in a Child : Case Report and Review of the Literature

“…Immature vessels left in the surgical bed may not be visible on angiography, but they may retain the ability to regrow and form a new malformation in the same location 5) . This hypothesis is supported by the findings of Klimo et al 11) , who reported that diffuse lesions were disproportionately represented in cases of failed obliteration, residual lesion, or recurrence. Sano et al 15) proposed a concept called "reserve nidus" which refers to abnormal vascular groups around the main nidus.…”

“…The second presentation would be more serious. There were two cases in which the lesion recurred twice in the literature, 3,4,11) and one case involved a woman who initially presented at the age of 33 years and experienced the second recurrence at the age of 42 3) .…”

“…Complete excision or obliteration of the lesion usually eliminates the risks of hemorrhage, and a negative cerebral angiogram is generally considered indicative of a cure. Although recurrence of cerebral AVMs is rare, there are several reports of cerebral AVM recurrence in both children 1,2,4,[9][10][11] and adults 3,5,8,16) after complete resection verified by postoperative angiography.…”

Microsurgical treatment of arteriovenous malformations in pediatric patients: the Boston Children's Hospital experience

“…It is intriguing that an extensive number of studies have reported using radiosurgery to manage AVMs in children. 1,3,5,6,20,25,28,30,34,40 By comparison, reports of surgical AVM series, summarized in Table 7, 2,5,8,9,[16][17][18]21,22,27,31 are sparse and contain fewer patients, but some describe better results after resection of AVMs in children than in adults. 31 Furthermore, as most pediatric AVMs in nearly all series are hemorrhagic, 2,8,9,16-18,22 a more aggressive, expedient therapy via microsurgery, as opposed to radiosurgery, should be sought in such cases.…”

“…Reports of treatment outcome in moderate-to large-size pediatric cohorts are rare. 2,5,16,18,22,27,31 We reviewed our own surgical experience with AVMs to elucidate obliteration rates and treatment results in the context of an evolved institutional protocol. …”