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Updated: May 28, 2026
Comprehensive Endovascular and Open Surgical Management of Cerebral Arteriovenous Malformations
Published on: October 20, 2017
Effective surgical treatment of cerebral cavernous malformations: a multicenter study of 79 pediatric patients
Michael Hugelshofer1, Nicola Acciarri, Ulrich Sure
1Department of Neurosurgery, University Hospital, Zürich, Switzerland.
Insights
Surgical resection of symptomatic cerebral cavernous malformations (CCMs) in children is effective, with over 77% becoming seizure-free post-operation. Lesion location did not significantly impact outcomes, suggesting resection is a favorable treatment option.
Area of Science:
- Neurology
- Neurosurgery
- Pediatric Neurology
Background:
- Cerebral cavernous malformations (CCMs) are prevalent brain vascular lesions, affecting 0.5% of the population.
- CCMs are a significant cause of brain hemorrhage in pediatric patients, presenting with seizures, headaches, and neurological deficits.
- Surgical resection is an option for symptomatic CCMs, particularly those causing medically refractory epilepsy.
Purpose of the Study:
- To evaluate the clinical outcomes of surgically treated pediatric patients with symptomatic CCMs.
- To compare outcomes based on the location of CCMs in children experiencing preoperative epileptic seizures.
Main Methods:
- Retrospective analysis of 79 pediatric patients (41 boys, 38 girls) from three centers, surgically treated for symptomatic CCMs between 1974 and 2004.
- Mean age at first manifestation was 9.7 years; mean age at operation was 11.3 years.
- Focus on comparing seizure outcomes (Engel Class I) relative to CCM location.
Main Results:
- 77.3% of pediatric patients achieved seizure freedom (Engel Class I) after CCM resection.
- No significant differences in seizure control outcomes were observed based on the location of the cerebral cavernous malformations.
Conclusions:
- Surgical resection of symptomatic CCMs is a favorable treatment for pediatric patients, similar to adults.
- The effectiveness of resection in achieving seizure freedom supports its consideration for symptomatic pediatric CCMs regardless of lesion location.
Object:
Cerebral cavernous malformations (CCMs) are common vascular lesions in the brain, affecting approximately 0.5% of the population and representing 10%-20% of all cerebral vascular lesions. One-quarter of all CCMs affect pediatric patients, and CCMs are reported as one of the main causes of brain hemorrhage in this age group. Symptoms include epileptic seizures, headache, and focal neurological deficits. Patients with symptomatic CCMs can be treated either conservatively or with resection if lesions cause medically refractory epilepsy or other persistent symptoms.
Methods:
The authors retrospectively analyzed 79 pediatric patients (41 boys and 38 girls) from 3 different centers, who were surgically treated for their symptomatic CCMs between 1974 and 2004. The mean age of the children at first manifestation was 9.7 years, and the mean age at operation was 11.3 years. The main goal was to compare the clinical outcomes with respect to the location of the lesion of children who preoperatively suffered from epileptic seizures.
Results:
Of these patients, 77.3% were seizure free (Engel Class I) after the resection of the CCM. Significant differences in the outcome between children who harbored CCMs at different locations were not found.
Conclusions:
Resection seems to be the favorable treatment of symptomatic CCMs not only in adults but also in children.
