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Comprehensive Endovascular and Open Surgical Management of Cerebral Arteriovenous Malformations
Published on: October 20, 2017
Pediatric arteriovenous malformations: a 15-year experience with an emphasis on residual and recurrent lesions
Paul Klimo1, Ganesh Rao, Douglas Brockmeyer
1Department of Neurosurgery, University of Utah, Primary Children's Medical Center, 100 N. Medical Drive, Salt Lake City, UT 84113, USA.
Insights
Microsurgical resection effectively treats pediatric arteriovenous malformations (AVMs), achieving high obliteration rates. Diffuse-type AVMs present greater challenges, with higher risks of residual disease and recurrence.
Area of Science:
- Neurosurgery
- Pediatric Neurology
- Vascular Malformations
Background:
- Pediatric arteriovenous malformations (AVMs) require effective treatment strategies.
- Microsurgical resection is the primary approach for pediatric AVMs.
- Understanding outcomes for residual or recurrent AVMs is crucial.
Observation:
- A 15-year review of 39 pediatric AVM patients (average age 10.3 years) was conducted.
- The study analyzed AVM obliteration, residual lesions, and recurrence rates.
- Mean follow-up was 30 months.
Findings:
- The overall long-term AVM obliteration rate was 89% following microsurgical resection.
- 23% of patients had residual AVMs after initial treatment, with 5 undergoing successful further treatment.
- 13% experienced recurrence within 6 years, particularly those with diffuse-type AVMs.
Implications:
- Microsurgical resection is a successful primary treatment for most pediatric AVMs.
- Endovascular and stereotactic radiosurgery serve as adjunct or alternative treatments.
- Diffuse-type AVMs require careful management due to higher recurrence and residual rates.
Object:
Pediatric arteriovenous malformations (AVMs) are generally treated with microsurgical resection to achieve complete obliteration. We review our experience treating AVMs in children, particularly those with residual or recurrent lesions.
Methods:
The records of 39 patients with AVMs (25 girls: 14 boys; average age 10.3 years) treated during a 15-year period were reviewed (mean follow-up 30 months). Three primary outcomes were analyzed: AVM obliteration by last follow-up, residual on postoperative angiograms and recurrence after angiographic "cure."
Results:
Most children (57%) presented with spontaneous intracerebral hemorrhage, the average nidus size was 3.4 cm, and the modal Spetzler-Martin grade was 2. AVMs were classified as compact (82%) or diffuse (18%). Most patients (90%) underwent surgery as their primary treatment. The immediate obliteration rate was 76% and the overall, long-term obliteration rate was 89%. Nine (23%) patients had residual nidus after initial treatment; five of these underwent further treatment that obliterated their lesion. Five (13%) patients developed recurrence within 6 years, including one patient with two recurrences. Three were successfully treated with a repeat resection. Patients with diffuse-type AVMs were at greater risk of having a persistent lesion (40%), residual lesion (44%), or recurrence (80%) at last follow-up.
Conclusion:
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.
