Diagnosis and management of arteriovenous malformations in children

Area of Science:

• Pediatric Neurology
• Neurosurgery
• Vascular Malformations

Background:

• Arteriovenous malformation (AVM) is the leading cause of spontaneous intraparenchymal hemorrhage in children, excluding neonatal causes.
• The natural history and optimal management of pediatric AVMs are poorly understood due to emergent initial treatment and presentation often following hemorrhage.
• Intracranial AVMs in children pose significant lifelong risks of hemorrhage and potential neurological deficits.

Purpose of the Study:

• To review the challenges and current management strategies for pediatric intracranial arteriovenous malformations.
• To emphasize the need for individualized, multidisciplinary treatment approaches for pediatric AVMs.
• To discuss the evolving armamentarium of treatment modalities for pediatric AVMs.

Main Methods:

• Review of current literature and treatment modalities for pediatric intracranial AVMs.
• Discussion of factors influencing treatment success, including AVM characteristics and patient condition.
• Evaluation of microsurgical resection, endovascular embolization, and radiosurgery as treatment options.

Main Results:

• Successful AVM treatment depends on lesion location, size, hemodynamics, patient status, and chosen modality.
• Microsurgical resection is the gold standard for accessible pediatric AVMs, particularly those presenting with hemorrhage.
• Embolization and radiosurgery offer valuable options for large or deep-seated AVMs unsuitable for surgery alone.

Conclusions:

• Individualized, multidisciplinary management is crucial for pediatric intracranial AVMs to preserve neurologic function and minimize mortality.
• A combination of treatment modalities may be necessary for complex cases.
• Long-term follow-up imaging is essential to detect potential AVM recurrence even after apparent obliteration.