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Comprehensive Endovascular and Open Surgical Management of Cerebral Arteriovenous Malformations
Published on: October 20, 2017
Evaluation of pediatric patients with vascular malformations managed with endovascular and radiosurgical techniques
Caleb E Feliciano1, Rafael Rodríguez-Mercado
1Department of Surgery, Section of Neurological Surgery, Neuroendovascular Surgery Program, University of Puerto Rico, Medical Sciences Campus, San Juan. cfeliciano@rcm.upr.edu
Insights
A modified Rankin Scale effectively evaluates functional status in pediatric patients with cerebrovascular malformations. This straightforward approach aids in categorizing outcomes, especially in retrospective studies.
Area of Science:
- Pediatric Neurology
- Neurosurgery
- Vascular Malformations
Background:
- Evaluating pediatric patients with cerebrovascular malformations presents challenges due to age and communication barriers.
- Existing functional evaluation scales may be difficult to apply in retrospective studies with limited data.
- There is a need for simpler scales to describe and categorize functional status in pediatric cerebrovascular cases.
Purpose of the Study:
- To assess the utility of a pediatric modification of the Rankin Disability Scale for functional evaluation in children undergoing treatment for cerebrovascular lesions.
- To determine the effectiveness of endovascular and radiosurgical treatments for pediatric cerebrovascular malformations.
Main Methods:
- A cohort of 24 pediatric patients (4 months to 17 years) with cerebrovascular lesions treated between 1997 and 2003 was analyzed.
- Patients received endovascular treatment, with most arteriovenous malformation cases also undergoing radiosurgery.
- Functional status was evaluated using a pediatric modification of the Rankin Disability Scale pre- and post-intervention.
Main Results:
- The combined embolization and radiosurgical approach resulted in a 4% mortality and 4% morbidity rate.
- A 46% cure rate was achieved for various pediatric vascular anomalies using the combined technique.
- Overall improvement in disability was observed in all patients, with a non-statistically significant trend towards improvement in the arteriovenous malformation subgroup (p = 0.0547).
Conclusions:
- A pediatric modification of the Rankin Disability Scale is a viable tool for functional evaluation in pediatric cerebrovascular patients.
- This modified scale offers a straightforward method for functional categorization, particularly beneficial for retrospective analyses.
- The study supports the use of this scale despite the availability of other validated instruments.
Background:
Pre- and postoperative evaluation of the pediatric patient with a cerebrovascular malformation can be cumbersome. This may be due to several factors, including age and ability to verbalize. Functional evaluation scales have been devised, yet application to a retrospective study, where information can be limited, may not be possible. Simpler scales, serving the purpose of functional description and categorization would be beneficial in these cases.
Methods:
Between December 1997 and December 2003, 24 patients between the ages of 4 months to 17 years old underwent endovascular treatment for cerebrovascular lesions at our institution. The majority of the arteriovenous malformation cases underwent further radiosurgical treatment. Mean follow-up period from the time of the last endovascular or radiosurgical intervention was 22 months. A pediatric modification of the Rankin Disability Scale was used for evaluation of pre-procedural and post-procedural functional status.
Results:
Combined embolization/radiosurgical approach had 4% mortality and 4% morbidity rates. This combined technique achieved a 46% cure in a variety of pediatric vascular anomalies. Overall improvement in disability using the pediatric modification of the Rankin Scale was noted for all of the cases, and a tendency for improvement was noted in the arteriovenous malformation subgroup though not statistically significant, p = 0.0547.
Conclusions:
These results indicate that a pediatric modification of the Rankin Disability Scale can be used for functional evaluation in this population. Although other functional evaluation scales are available and validated, using a Rankin Disability Scale modification is straightforward, and it can provide functional categorization in retrospective studies.
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