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Comprehensive Endovascular and Open Surgical Management of Cerebral Arteriovenous Malformations
Published on: October 20, 2017
Management of intracranial cavernous malformation in pediatric patients
Jae-Whan Lee1, Dong-Seok Kim, Kyu-Won Shim
1Department of Neurosurgery, Brain Korea 21 Project for Medical Science, Brain Research Institute, Yonsei University College of Medicine, 134 Sinchon-dong, Seodaemun-gu, Seoul 120-752, South Korea.
Insights
Pediatric cavernous malformations (CMs) are best managed with surgery. Surgical removal of these central nervous system vascular malformations effectively prevents hemorrhage and controls seizures in children.
Area of Science:
- Neurology
- Neurosurgery
- Pediatric Medicine
Background:
- Cavernous malformations (CMs) are vascular anomalies of the central nervous system.
- Pediatric CMs exhibit distinct origins and clinical features compared to adult cases.
Purpose of the Study:
- To report on the management experience of pediatric intracranial cavernous malformations.
- To evaluate the efficacy of microsurgery and radiosurgery in this population.
Main Methods:
- Retrospective review of 33 pediatric patients (<20 years) with intracranial CMs treated between 1994-2006.
- Treatments included microsurgery (75.8%) and radiosurgery (24.2%).
Main Results:
- Seizures were the most common presenting symptom (57.6%).
- Type II CMs were most frequent (54.5%), predominantly in the supratentorial compartment (71.8%).
- Microsurgery achieved complete prevention of recurrent hemorrhage and seizure control in all cases, with only 6.1% experiencing persistent symptoms.
Conclusions:
- Surgical treatment is recommended for pediatric symptomatic CMs.
- Surgery offers significant benefits, including prevention of recurrent hemorrhage and control of neurological deficits.
Objective:
Cavernous malformations (CMs) are vascular malformations affecting any part of the central nervous system. CMs in the pediatric age group are known to be different from those of adults both in origin and clinical characteristics. In this paper, we report our experience in managing CMs in pediatric patients.
Materials And Methods:
Between January 1994 and December 2006, 33 patients younger than 20 years of age with intracranial CMs were treated with microsurgery or radiosurgery. We retrospectively reviewed the presentation and treatment of these 33 patients (18 boys and 15 girls; average age 11.6 years).
Results:
The most common symptom at presentation was seizure (19 children, 57.6%). The most common type of CM, classified on the basis of magnetic resonance imaging, was type II (18, 54.5%). The supratentorial compartment was the most frequent location (27, 71.8%), and only six CMs (18.2%) were observed in the infratentorial compartment. Microsurgery was performed on 25 patients (75.8%), and radiosurgery was performed on eight patients (24.2%). The overall post-treatment results were positive. Only two children (6.1%) had persistent presurgical neurological signs, although the treatment ameliorated them. No progression of the preoperative neurological signs or onset of new neurological deficits was seen in any of the patients. In our patient group, the microsurgical removal of CMs resulted in the prevention of recurrent hemorrhage and the control of seizure disorders in all cases.
Conclusions:
Our results suggest that pediatric patients with symptomatic CMs should be treated surgically because of the risk of recurrent hemorrhaging and the general benefits of CM removal.
