Pediatric intracranial arteriovenous malformations: a single-center experience

Abstract

<jats:sec><jats:title>OBJECTIVE</jats:title><jats:p>Intracranial arteriovenous malformations (AVMs) are a common cause of intracranial hemorrhage in children. Exploring outcomes of treatment and factors that predict recurrence may help guide the management of pediatric AVMs. In this study, the authors review a single-center experience with pediatric AVMs, aiming to identify factors contributing to recurrence and areas for improvement in treatment.</jats:p></jats:sec><jats:sec><jats:title>METHODS</jats:title><jats:p>A single-center retrospective review of patients ages 0–18 years with AVMs in the period from 2005 to 2018 was conducted. Demographic, clinical, and radiographic data were collected and examined to compare the clinical and functional outcomes of patients managed with and those managed without open microsurgical resection.</jats:p></jats:sec><jats:sec><jats:title>RESULTS</jats:title><jats:p>One hundred five patients were diagnosed and treated during the study period. Fifty (47.6%) had been treated surgically and 35 (33.3%) nonsurgically, and 20 (19%) had been treated primarily at an outside institution and thus were excluded from further analysis. Of the 50 treated surgically, 92% had complete obliteration on postoperative imaging, with the remaining patients having residual AVM and undergoing re-resection or SRS, ultimately resulting in a 96% radiographic cure rate. The surgically treated patients were followed up for an average of 3.34 years. Eighty-two percent had a modified Rankin Scale (mRS) score of 0–2. There was a recurrence rate of 12%, with the time to recurrence averaging 327.86 days (range 85–596 days). Of the 35 patients managed without open surgery, 77% underwent serial imaging surveillance, 20% underwent endovascular embolization, and 3% underwent stereotactic radiosurgery. Radiographic cure was seen in 6% of those treated nonsurgically, and all had undergone endovascular treatment alone. The nonsurgically treated patients were followed up for an average of 2.14 years. Eighty percent had an mRS score of 0–2.</jats:p></jats:sec><jats:sec><jats:title>CONCLUSIONS</jats:title><jats:p>The data revealed that patients with lower-grade AVMs treated surgically and those with higher-grade AVMs managed without surgery have good functional and clinical outcomes. A high rate of recurrence was noted, and the possible contributing factors were explored. The authors encourage further study into mechanisms to reduce AVM recurrence in pediatric patients and look forward to advances in the medical management of lesions that are considered unresectable.</jats:p></jats:sec>

Endovascular embolization for cases of ‘hidden’ pediatric cerebral arteriovenous malformations: A diagnostic & therapeutic challenge

“…Pediatric arteriovenous malformations are more prevalent as the cause of spontaneous intracerebral hemorrhage in compared to those in adults [3] . The percentage may reach around 30%–50% in paediatrics, while in adults the number sits at around 1.4, – 2% [4] .…”

“…The gold standard diagnostic modality for cases of arteriovenous malformation is conventional cerebral angiography [16] . Conservatively managed pediatric arteriovenous malformation are reported to have an annual risk of rupture of 4.4%–5.5% [3] . Therapeutic modalities of pediatric intracranial include; observation and medications; surgical resection, which is the remaining gold-standard therapy; endovascular embolization; radiosurgery; and their combinations [4] , [5] .…”

“…Arteriovenous malformations may or may not produce symptoms; some remain silent for a long period of time, or can lead to seizures or rupture resulting in severe hemorrhage and debilitating neurologic sequelae. In pediatric populations, ruptured AVM hold a larger proportion as the cause of spontaneous intracranial hemorrhage than in adults [3] . The percentage may reach around 30%–50% in pediatric, while in adults the number sits at around 1.4, - 2% [4] .…”

“…The percentage may reach around 30%–50% in pediatric, while in adults the number sits at around 1.4, - 2% [4] . Conservatively managed paediatrics arteriovenous malformations are reported to have an annual risk of rupture of 4.4%–5.5% [3] . This number is significantly reduced after treatment, and this justifies early intervention of pediatric intracranial arteriovenous malformations [4] , [5] .…”

“…To help ease surgical resection, several endovascular modalities such as embolization may be useful in reducing the flow of larger arteriovenous malformations [8] . This may alleviate the symptoms of patients and shrink the lesion to increase the efficacy of further therapeutic approach such as surgery or radiosurgery [3] .…”