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Comprehensive Endovascular and Open Surgical Management of Cerebral Arteriovenous Malformations
Published on: October 20, 2017
Multimodal Treatment of Pediatric Ruptured Brain Arteriovenous Malformations: A Single-Center Study
Lukasz Antkowiak1, Monika Putz1, Marta Rogalska2
1Department of Pediatric Neurosurgery, Medical University of Silesia, 40-752 Katowice, Poland.
Insights
Pediatric ruptured brain arteriovenous malformations (bAVMs) treated with microsurgery, embolization, or radiosurgery showed no mortality or rebleeding. Most patients achieved favorable outcomes, highlighting the safety and effectiveness of multimodality treatment for pediatric bAVMs.
Area of Science:
- Neurology
- Neurosurgery
- Pediatric Medicine
Background:
- Ruptured brain arteriovenous malformations (bAVMs) are a leading cause of intracranial hemorrhage in children.
- Preventing rebleeding and reducing associated morbidity/mortality are critical treatment goals.
Purpose of the Study:
- To evaluate clinical outcomes in pediatric patients with ruptured bAVMs.
- To review the institutional experience with multimodality treatment for pediatric ruptured bAVMs.
Main Methods:
- Retrospective review of pediatric patients with ruptured bAVMs treated between 2011-2020.
- Interventional treatments included microsurgery, embolization, or radiosurgery, used alone or in combination.
- Clinical outcomes assessed via Modified Rankin Scale (mRS) and complication/rebleeding rates.
Main Results:
- 22 pediatric patients were identified with no intraoperative or postoperative intervention-related mortality.
- No procedure-related complications or rebleeding occurred after treatment.
- 19 patients (86.4%) had favorable outcomes (mRS 0-2); 3 (13.6%) had disabilities (mRS 3).
- Microsurgery achieved complete obliteration in all cases with available postoperative DSA.
- Radiosurgery or embolization for high-grade bAVMs yielded satisfactory outcomes with low disability risk.
Conclusions:
- Multimodality treatment is safe and effective for pediatric ruptured bAVMs.
- Favorable outcomes and low complication rates were observed across different interventional approaches.
- Management strategies, including radiosurgery and embolization, can effectively treat high-grade bAVMs in children.
Abstract:
Bleeding from ruptured brain arteriovenous malformations (bAVMs) represents the most prevalent cause of pediatric intracranial hemorrhage, being also the most common initial bAVM manifestation. A therapeutic approach in these patients should aim at preventing rebleeding and associated significant morbidity and mortality. The purpose of this study was to determine the clinical outcomes of pediatric patients who initially presented at our institution with ruptured bAVMs and to review our experience with a multimodality approach in the management of pediatric ruptured bAVMs. We retrospectively reviewed pediatric patients' medical records with ruptured bAVMs who underwent interventional treatment (microsurgery, embolization, or radiosurgery; solely or in combination) at our institution between 2011 and 2020. We identified 22 patients. There was no intraoperative and postoperative intervention-related mortality. Neither procedure-related complications nor rebleeding were observed after interventional treatment. Modified Rankin Scale (mRS) assessment at discharge revealed 19 patients (86.4%) with favorable outcomes (mRS 0-2) and 3 patients (13.6%) classified as disabled (mRS 3). Microsurgery ensured the complete obliteration in all patients whose postoperative digital subtraction angiography (DSA) was available. Management of high-grade bAVMs with radiosurgery or embolization can provide satisfactory outcomes without a high disability risk.
