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Updated: Jun 18, 2026
Comprehensive Endovascular and Open Surgical Management of Cerebral Arteriovenous Malformations
Published on: October 20, 2017
Multimodality treatment of cerebral AVMs in children: a single-centre 20 years experience
Christian Dorfer1, Thomas Czech, Gerhard Bavinzski
1Department of Neurosurgery, Medical University Vienna, Waehringer Guertel 18-20, 1090 Vienna, Austria. christian.dorfer@meduniwien.ac.at
Insights
Multimodality treatment effectively manages pediatric cerebral arteriovenous malformations (AVMs), achieving high rates of complete obliteration and excellent clinical outcomes in children. This combined approach offers a promising strategy for AVM care.
Area of Science:
- Pediatric Neurosurgery
- Interventional Neuroradiology
- Radiation Oncology
Background:
- Cerebral arteriovenous malformations (AVMs) pose significant risks in children, often presenting after rupture.
- Management requires tailored strategies due to the complexity of pediatric AVMs.
Observation:
- A retrospective analysis of 56 children with cerebral AVMs treated between 1988 and 2008 was conducted.
- The study evaluated a multimodality treatment approach combining microsurgery, endovascular treatment, and gamma knife radiosurgery.
Findings:
- 64.3% of pediatric AVM patients presented with AVM rupture.
- Single treatment modalities achieved angiographic cure in 30.9% of patients.
- A combined treatment strategy was employed in 69.1% of patients, with embolization followed by radiosurgery being the most common (38.2%).
- Complete angiographic obliteration was achieved in 93.3% of patients.
- Excellent clinical outcomes (Glasgow Outcome Scale 5 and 4) were observed in 94.6% of children.
Implications:
- Multimodality treatment is highly effective for pediatric cerebral AVMs.
- This approach leads to excellent angiographic and clinical outcomes, improving patient prognosis.
- The findings support the use of combined therapeutic strategies for complex pediatric AVM cases.
Purpose:
The purpose of this study was to review our experience with a multimodality treatment approach in the management of cerebral arteriovenous malformation (AVM) in children.
Methods:
We retrospectively analysed a consecutive series of 56 children who harboured a cerebral AVM and were treated at our institution between 1988 and 2008. During the whole treatment period, a combined treatment strategy, including microsurgery, endovascular treatment and gamma knife radiosurgery, was used.
Results:
Of the 56 patients (median age, 14.0; range, 3 months-18 years) reported, 36 (64.3%) were admitted after AVM rupture; of these, only one AVM (1.8%) was considered untreatable. In 30.9% (17/55) of the treated patients, a single treatment measure was sufficient to attain angiographic cure of the AVM. Among these, six patients (10.9%) had microsurgical AVM resection, four patients (7.3%) underwent endovascular treatment, and another seven patients (12.7%) underwent radiosurgical management of the AVM. The majority of the population (38/55; 69.1%) underwent combined treatment: 21 patients (38.2%) received embolisation followed by radiosurgery of the remnant nidus, ten patients (18.2%) underwent embolisation with subsequent surgical resection of the residual AVM, three patients (5.5%) had radiosurgery after incomplete surgical AVM nidus resection and another four patients (7.3%) required a combination of all three treatment modalities to achieve permanent angiographic cure of the AVM. We observed good clinical outcomes (Glasgow Outcome Scale 5 and 4) in 94.6% of the children. Complete angiographic obliteration was achieved in 93.3% of the patients treated.
Conclusion:
A multimodality treatment approach in children harbouring cerebral AVMs leads to excellent angiographic and clinical outcomes.
