Pediatric intracranial arteriovenous malformations: Examining rehabilitation outcomes

LoPresti, Melissa A.; Giridharan, Nisha; Pyarali, Monika; Gadgil, Nisha; Kan, Peter; Niedwiekci, Christian; Lam, Sandi

doi:10.3233/prm-190609

Cited by 6 publications

(4 citation statements)

References 31 publications

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“…Our cases were somewhat older than those studied by Blauwblomme et al where the mean age of their cases was around 10 years (116 months), 16 and LoPresti et al where the mean age was around 9.8 years. 17 Cases of Mendes et al and Park et al were older than ours, with a mean age of 13-13.5 years. 18,19 There was slight female preponderance (64.91%) among the current study cases.…”

Section: Discussioncontrasting

confidence: 44%

“…The frontal predominance was found in the study of LoPresti et al where they stated frontal involvement in 40% of the cases, followed by parietal (26%), and temporal (24%) lobes. 17 The study of Mendes et al showed somewhat different distribution, where 2 out of their 7 cases had either frontal, temporal or corpus callosum location and the seventh case had parietal hemorrhage. 18 Di Rocco et al stated that temporal location was the most common one among their cases, followed by parietal, frontal, cerebellar and finally brainstem.…”

Section: Discussionmentioning

confidence: 94%

“…19 The study of LoPresti et al showed that the main complications of non-surgically treated cases included rupture in 6 patients, hydrocephalus in 6 patients and neurological deficit in 3 patients out of the total of 35 cases. 17 Embolization-related complications were usually transient and very low. They were reported in a comparable percent to those occurring after microsurgery or radiosurgery.…”

Section: Discussionmentioning

confidence: 99%

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Long-Term Outcomes after Endovascular Oblitraion of Pediatric Arteriovenous Malformation : A Multi-Center Analysis

Sultan

Abouzeid²,

Shadad³

2022

Pan Arab Journal of Neurosurgery

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BACKGROUND:Although pediatric arteriovenous malformations (AVMs) are relatively rare, they carry a higher rate of rupture than in adults. Pediatric AVMs could also present with recurrent seizures or headaches. Endovascular embolization is usually achievable in pediatric AVMs with increasing complete obliteration rates, especially in cases with small AVMs. It also serves as adjuvant therapy with microsurgery or radiosurgery in larger AVMs. Long-term follow-up is required to confirm the efficiency of endovascular AVM obliteration, especially in young populations with the longest life expectancy. OBJECTIVE:The aim of the study was to perform a multicenter analysis of embolized pediatric cerebral AVMs regarding the clinical and radiological outcomes with a long term follow up. METHODS:A retrospective study of 57 pediatric patients diagnosed with cerebral AVMs and admitted to departments of neurosurgery at Alexandria, Sohag and Tanta University hospitals was conducted. All patients were subjected to clinical and radiological assessments. Endovascular embolization was done for all cases in one or two sessions. Complementary treatment included microsurgery and radiosurgery. Clinical and radiological follow-ups were done for all patients for at least one year. The outcome measures were angiographic disappearance of the AVM nidus and neurological improvement on clinical followup. RESULTS:The study included 57 pediatric patients with age range between 4-18 years. Fifty-four patients (94.73%) presented with intracranial hemorrhage and 3 patients (5.26%) presented with seizures. All patients were treated with endovascular embolization as a primary modality of treatment. Total obliteration of the AVM was achieved in one session in 30 patients (52.63%) and in 2 sessions in 8 patients (14.03%). After endovascular embolization, 7 patients (12.28%) underwent microsurgical excision, and another 12 patients (21.05%) were referred to radiosurgery. All patients had no permanent morbidity or mortality related to the embolization technique. Five patients (8.77%) had transient neurological deficits. One patient had minimal subarachnoid hemorrhage (SAH) due to microwire perforation and another patient had temporary pulmonary edema due to the effect of dimethyl sulfoxide on lung; both patients improved with medical treatment. One patient had a retained tip of a microcatheter which was removed with surgery.CONCLUSION: Endovascular embolization is a safe and effective technique as a single modality in the management of pediatric AVMs. It has extended the role of microsurgery and radiosurgery to treat previously non-curable high-grade lesions. Long-term follow-up over 3 years confirms stable occlusion. A longer follow-up is still needed due to the long life expectancy.

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Section: Discussioncontrasting

confidence: 44%

Section: Discussionmentioning

confidence: 94%

Section: Discussionmentioning

confidence: 99%

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Long-Term Outcomes after Endovascular Oblitraion of Pediatric Arteriovenous Malformation : A Multi-Center Analysis

Sultan

Abouzeid²,

Shadad³

2022

Pan Arab Journal of Neurosurgery

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“…The resulting tortuous, pressurized blood supply predisposes to rupture, which can lead to lifelong disability or death. 1 , 2 The most common presentation is intracranial hemorrhage, occurring in 52% of all cases and 69% of childhood cases. 3 , 4 Although AVMs are rare in children, they are considered the primary cause of hemorrhagic stroke in the pediatric population and carry a 25% mortality rate.…”

mentioning

confidence: 99%

Microsurgical resection of a ruptured intraventricular arteriovenous malformation in a neonate: considerations in management. Illustrative case

Stone,

Colliander,

LoPresti

et al. 2023

Journal of Neurosurgery: Case Lessons

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BACKGROUND Arteriovenous malformations (AVMs) are the most common cause of intracranial hemorrhage in children, although they are rarer in neonates. Age, location, lesion architecture, and rupture status define treatment options. Sparse literature exists to guide the management of clinically symptomatic intraventricular AVM rupture in neonates. We highlight the case of a neonate with a ruptured intraventricular AVM to showcase considerations in treatment, discuss surgical technique, and help guide management. OBSERVATIONS An 18-day-old female presented with lethargy in extremis and was found to have new intraventricular hemorrhage. Angiogram revealed a Spetzler-Martin grade 2 AVM with a right posterior choroidal feeder and deep venous drainage within the ventricle. Her age limited radiosurgical and endovascular interventions. She underwent an interhemispheric, transcollosal, intraventricular approach for complete AVM resection. Perioperative care was managed by a multidisciplinary team, successfully mitigating the patient’s high risk of hemovascular collapse. LESSONS Stereotactic radiosurgery, endovascular embolization, and microsurgery are options for AVM obliteration, and multimodal therapy must be tailored to the lesion and patient. Conservative management can also be considered. Each intervention carries risks and varying likelihoods of success. Balancing these outcomes is challenging without definitive, high-quality, evidence-based guidance. The best treatment maximizes the chance of AVM obliteration while minimizing morbidity.

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Response: Letter to the Editor regarding “Natural history of high-grade pediatric arteriovenous malformations: implications for management options”

LoPresti

Lam

2020

Childs Nerv Syst

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Pediatric intracranial arteriovenous malformations: Examining rehabilitation outcomes

Cited by 6 publications

References 31 publications

Long-Term Outcomes after Endovascular Oblitraion of Pediatric Arteriovenous Malformation : A Multi-Center Analysis

Long-Term Outcomes after Endovascular Oblitraion of Pediatric Arteriovenous Malformation : A Multi-Center Analysis

Microsurgical resection of a ruptured intraventricular arteriovenous malformation in a neonate: considerations in management. Illustrative case

Response: Letter to the Editor regarding “Natural history of high-grade pediatric arteriovenous malformations: implications for management options”

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