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Updated: Dec 21, 2025
Comprehensive Endovascular and Open Surgical Management of Cerebral Arteriovenous Malformations
Published on: October 20, 2017
[Arteriovenous malformations of the brain in children: treatment results for 376 patients]
Sh Sh Eliava1, Yu V Pilipenko1, S B Yakovlev1
1Burdenko Neurosurgical Center, Moscow, Russia.
Insights
Cerebral arteriovenous malformations (AVM) in children rarely cause early re-bleeding, making urgent surgery unnecessary unless there
Area of Science:
- Pediatric Neurosurgery
- Cerebrovascular Diseases
- Medical Interventions
Background:
- Cerebral arteriovenous malformations (AVM) are increasingly diagnosed in pediatric populations.
- Intracranial hemorrhage is a significant complication, affecting over 70% of pediatric AVM patients.
- Understanding hemorrhage risk and treatment outcomes is crucial for managing pediatric cerebral AVM.
Purpose of the Study:
- To assess hemorrhage risk in children with cerebral AVM before and after treatment.
- To evaluate the effectiveness of different management strategies for pediatric cerebral AVM.
Main Methods:
- A retrospective study of 376 pediatric patients (<18 years) with cerebral AVM.
- Analysis of hemorrhage rates, treatment modalities (microsurgery, endovascular, radiosurgery), and outcomes.
- Inclusion of data on patient demographics, AVM types, and post-treatment follow-up.
Main Results:
- Angiomatous AVM had a 1.1% hemorrhage risk pre-treatment, while fistulous AVMs had 15.4%.
- Microsurgical resection (35.9% of patients) achieved 97.8% total resection with no mortality.
- Endovascular treatment (21%) and radiosurgery (37.2%) showed varying obliteration rates and associated risks, with overall favorable outcomes (89.6%) reported.
Conclusions:
- Early re-hemorrhage is uncommon in pediatric cerebral AVM, negating the need for urgent intervention unless intracerebral hematoma is present.
- Microsurgery is preferred for angiomatous AVMs, endovascular treatment for fistulous AVMs, and radiosurgery offers favorable outcomes.
- Radiosurgery for pediatric AVMs is effective, and delaying treatment due to obliteration time is not advised for high-risk cases.
Undefined:
Cerebral arteriovenous malformations (AVM) are increasingly detected in children.
Objective:
To estimate the risk of hemorrhage in children with AVM before and after treatment and evaluate the outcomes of various methods of AVM management in children.
Material And Methods:
This study included 376 patients with various cerebral AVM under the age of 18 years. There were 273 patients with intracranial hemorrhage (72.6%).
Results:
Recurrent hemorrhages within the first month were registered in 1.1% of patients with angiomatous AVM prior to treatment and in 15.4% of patients with fistulous AVM. Microsurgical resection of AVM was performed in 135 (35.9%) patients. Total resection was achieved in 97.8% of cases. There were no mortality after microsurgical procedures. Endovascular treatment was applied in 79 (21%) patients. Total embolization was achieved in 29.1% of patients. One patient (1.3%) died after endovascular procedure. Radiosurgery was performed in 140 (37.2%) patients with total obliteration after a single fraction in 64.4% of patients. Favorable long-term outcomes (GOS grades V-IV) were achieved in 89.6% of patients with available follow-up data (n=182). Recurrent hemorrhages were registered in 6% of patients (3.3% after radiosurgery, 2.7% after endovascular treatment). One patient with recurrent hemorrhage died after radiosurgery.
Conclusion:
Early relapses of hemorrhage are not characteristic for children with cerebral AVM. Therefore, there are no indications for urgent surgery except for cases of intracerebral hematoma. In children, microsurgical treatment is preferred for angiomatous AVM, endovascular treatment - for fistulous AVM. Radiosurgery also ensures favorable outcomes. However, it is unreasonable to postpone AVM radiosurgical treatment in children with increased risk of recurrent hemorrhage considering relatively long period of post-radiation obliteration of AVM.
