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The management of arteriovenous malformations in children
G M Malik1, B Sadasivan, R S Knighton
1Department of Neurosurgery, Henry Ford Hospital Division, Detroit, MI 48202.
Insights
Surgical excision is the best treatment for pediatric arteriovenous malformations (AVMs). This study found that 85% of children undergoing AVM excision had excellent or good outcomes, with an overall mortality of 7%.
Area of Science:
- Pediatric Neurosurgery
- Vascular Surgery
- Pediatric Cardiology
Background:
- Arteriovenous malformations (AVMs) in children present unique management challenges.
- Early diagnosis and intervention are crucial for improving outcomes in pediatric AVM cases.
Purpose of the Study:
- To evaluate the long-term outcomes of pediatric patients with AVMs.
- To determine the efficacy of surgical excision versus conservative management for pediatric AVMs.
Main Methods:
- Retrospective review of 46 pediatric patients diagnosed with AVMs between 1941 and 1989.
- Analysis of patient demographics, AVM characteristics, clinical presentation, treatment modalities, and outcomes.
- Comparison of results between surgical excision and medical management.
Main Results:
- The overall mortality rate was 7%.
- Eighty-five percent of children who underwent surgical excision of AVMs achieved excellent or good results.
- Medical management of AVMs with a history of hemorrhage resulted in re-hemorrhage in 70% of cases.
Conclusions:
- Surgical excision is the most effective treatment for pediatric AVMs, offering high rates of excellent or good outcomes.
- Early surgical intervention for pediatric AVMs is associated with better results and reduced risk of complications.
- Aggressive management, including surgical excision, should be considered for pediatric AVMs, particularly those presenting with hemorrhage.
Abstract:
Between January 1941 and June 1989, 46 children below the age of 18 with an arteriovenous malformation (AVM) were managed. There were 7 patients with AVM diagnosed before the age of 2; 10 patients were diagnosed between the ages of 3 and 10; and 29 patients were diagnosed between 11 and 18. There were equal numbers of male and female patients. Twenty-five of the AVMs were large (greater than 5 cm longest diameter). All 7 AVMs diagnosed before the age of 2 were large. The usual clinical presentation was congestive heart failure, bruit and an enlarging head. Three patients underwent excision with 2 deaths and 1 excellent result. In 11 patients (aged 3-18) with AVM without history of hemorrhage, 3 had excision with 2 excellent and 1 fair result. Four remained stable. Four developed progressive deficits or hemorrhage. In 10 patients (aged 3-18) with AVM and hemorrhage who were treated medically, 7 (70%) had an episode of re-hemorrhage. Three patients had excision of AVM after re-hemorrhage, but before the age of 18 with an excellent result. Eighteen patients (aged 3-18) with AVM and a single episode of hemorrhage underwent excision with 17 excellent or good results and 1 fair result. The overall mortality was 7%. Eighty-five percent of the children with excision of AVM had an excellent or good result. The best treatment for AVM in children is surgical excision.