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Updated: Aug 6, 2026
Comprehensive Endovascular and Open Surgical Management of Cerebral Arteriovenous Malformations
Published on: October 20, 2017
Superior outcomes in children compared with adults after microsurgical resection of brain arteriovenous malformations
René O Sanchez-Mejia1, Sravana K Chennupati, Nalin Gupta
1Department of Neurological Surgery, University of California, San Francisco, California, USA.
Insights
Children experience better outcomes after arteriovenous malformation (AVM) resection than adults. This study found no anatomical or treatment differences, suggesting neural plasticity may explain children's superior recovery from AVM surgery.
Area of Science:
- Neurosurgery
- Pediatric Neurology
- Vascular Malformations
Background:
- Younger age is linked to better outcomes in arteriovenous malformation (AVM) resection.
- Previous studies suggest improved results in children, but the reasons remain unclear.
Purpose of the Study:
- To investigate why children achieve better outcomes than adults after microsurgical AVM resection.
- To identify if differences in AVM anatomy, rupture status, neurological condition, or treatment techniques explain the age-related outcome disparity.
Main Methods:
- A comparative study of pediatric and adult patients undergoing microsurgical AVM resection.
- Outcomes were assessed using the modified Rankin Scale (mRS).
- Patient characteristics, AVM anatomy, and treatment details were analyzed and compared between age groups.
Main Results:
- Complete AVM resection rates were high and similar in both groups (97% in children, 98% in adults).
- Children showed significantly better final mRS scores and more favorable neurological improvement (94% improved/unchanged vs. 70% in adults).
- No significant differences were found in clinical presentation, AVM anatomy, or surgical techniques between pediatric and adult cohorts.
Conclusions:
- Children consistently achieve superior outcomes compared to adults following microsurgical AVM resection.
- The observed benefits in children cannot be attributed to AVM characteristics or treatment variations.
- Enhanced neural plasticity in children is hypothesized to contribute to better surgical tolerance and recovery, supporting aggressive surgical management in this population.
Object:
Young age is considered an important factor in determining outcomes after microsurgical resection of arteriovenous malformations (AVMs), but better results in children have not been adequately explained. A consecutive series of pediatric and adult patients was reviewed to determine whether differences in outcomes between these two groups were due to differences in AVM anatomy, rupture rates, neurological condition at presentation, treatment techniques, or other causes.
Methods:
As assessed using the modified Rankin Scale (mRS), patient characteristics, clinical presentation, AVM anatomy, treatment techniques, and outcomes were compared between age groups. Thirty-two pediatric and 192 adult patients underwent microsurgical AVM resection during a 6.4-year period; complete resection was achieved in 97% of the children and 98% of adults. Superior outcomes were observed in children, who had better final mRS scores (p = 0.003) and more favorable changes in these scores (the condition of 94% of children improved or remained unchanged, compared with 70% of adults; p = 0.001). The change in the mean mRS scores was 1.31 for children and 0.14 for adults (p = 0.001). There were no significant clinical, anatomical, or therapeutic differences between children and adults.
Conclusions:
This analysis confirms the observation that children fare better than adults after microsurgical AVM resection. This discrepancy cannot be explained by differences in AVM anatomy, lesion rupture rates, presenting neurological condition, or treatment techniques, leading the authors to infer that neural plasticity may augment surgical tolerance and recovery in children. These findings bolster the choice of aggressive microsurgical management of AVMs and recalibration of surgical risk assessment in children.
