Related Experiment Video
Updated: Jun 10, 2026
Comprehensive Endovascular and Open Surgical Management of Cerebral Arteriovenous Malformations
Published on: October 20, 2017
[Urgent removal of ruptured cerebral arteriovenous malformations in children]
Mony Benifla1, Ilan Shelef, Israel Melamed
1Pediatric Neurosurgical Unit, Neurosurgery Department, Soroka Medical Center and Faculty of Health Sciences Ben Gurion University Beer Sheba, Israel. moni@bgu.ac.il
Insights
Urgent surgical removal of ruptured cerebral arteriovenous malformations (AVMs) in children can lead to complete neurological recovery. This approach, though rarely used, offers a viable option for acute AVM rupture with significant hemorrhage.
Area of Science:
- Pediatric Neurosurgery
- Neurology
- Vascular Malformations
Background:
- Arteriovenous malformations (AVMs) in children frequently present with intracranial hemorrhage following rupture.
- Acute rupture can cause severe complications like compressive hematoma and coma.
Observation:
- This study reports on 3 pediatric cases (5 months, 7, and 9 years) with ruptured AVMs presenting with rapid neurological decline.
- All patients exhibited decreased consciousness and mass effect due to intracerebral hemorrhage.
Findings:
- Urgent craniotomy for hematoma evacuation and AVM resection was performed within hours of bleeding.
- Minimal invasive techniques were employed for acute-stage AVM resection due to active bleeding.
- All 3 children achieved full neurological recovery with no deficits after one year, confirmed by angiography.
Implications:
- Early surgical intervention for ruptured AVMs in children is a feasible and effective treatment option.
- This contrasts with traditional approaches that often favor late-stage intervention.
- Management strategies for pediatric AVMs should consider urgent resection in acute rupture scenarios.
Abstract:
In 60-80% of children with arteriovenous malformation (AVM), the first manifestation is an abrupt rupture resulting in intracranial hemorrhage. Some cases of acute rupture result in compressive hematoma, severe mass effect and comatose patients. Acute surgery on cerebral arteriovenous malformations (AVMs) has seldom been reported or used. The authors present case reports of 3 children (ages: five months, 7 and 9 years) who underwent craniotomy for intraparenchymal hematoma evacuation and AVM removal within a few hours of bleeding. All 3 children arrived with decreased Levels of consciousness and rapid neurological deterioration. The 5 months old boy also suffered hypovolemic shock. The fast neurological worsening and mass effect of the extensive intracerebral hemorrhage prompted early surgical treatment. Due to active bleeding from the AVM, it was already resected in the acute stage using minimal invasive techniques. After one year of follow-up, all 3 children fully recovered with no neurological deficit. Post-operative angiography was performed to confirm that the malformation was totally removed. The management of AVM should include formal angiography, with or without endovascular embolization and late surgery when indicated. In this report, the authors presented 3 children who underwent urgent resection of the lesion with full neurological recovery. The management of AVM is reviewed with comparisons between surgical resection in the acute phase versus the late phase.
