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Updated: Nov 8, 2025
Comprehensive Endovascular and Open Surgical Management of Cerebral Arteriovenous Malformations
Published on: October 20, 2017
Arteriovenous Malformations-Associated Epilepsy in Pediatrics
Marc Prablek1, Melissa A LoPresti2, Rebecca Du3
1Department of Neurosurgery, Baylor College of Medicine, Texas Children's Hospital, 7200 Cambridge Ave, Suite 9A, Houston, TX, 77030, USA. Marc.prablek@bcm.edu.
Insights
Pediatric cerebral arteriovenous malformation (AVM) treatment, especially surgery, significantly improves epilepsy outcomes. Most children achieved seizure freedom or excellent seizure control after AVM treatment, with low recurrence rates.
Area of Science:
- Pediatric Neurology
- Neurosurgery
- Epileptology
Background:
- Cerebral arteriovenous malformations (AVMs) are a significant cause of epilepsy in children.
- Pediatric AVM-associated epilepsy requires effective long-term management strategies.
Purpose of the Study:
- To evaluate the long-term epilepsy outcomes in pediatric patients treated for cerebral arteriovenous malformations (AVMs).
- To assess the impact of multimodality AVM treatment on seizure control and functional outcomes in children.
Main Methods:
- Retrospective chart review of pediatric patients with AVM-associated epilepsy (2005-2018).
- Analysis of demographic data, treatment modalities (surgical resection, embolization, conservative management), and epilepsy outcomes (seizure freedom, Engel Class).
Main Results:
- Of 18 pediatric patients with AVM-related epilepsy, 13 underwent surgical resection with 92.31% achieving complete AVM resection.
- Postoperatively, 61.54% achieved seizure freedom, and 92.31% were modified Engel Class I.
- 80% of patients treated without open surgery (conservative or embolization) also achieved seizure freedom.
Conclusions:
- Multimodality treatment of cerebral arteriovenous malformations in pediatric patients leads to favorable long-term epilepsy outcomes.
- Surgical AVM treatment offers significant seizure control, with high rates of seizure freedom and excellent functional outcomes.
- Further research is needed to fully characterize long-term outcomes for pediatric AVM-associated epilepsy.
Purpose:
Seizures are the second most common presentation of cerebral arteriovenous malformations (AVMs); pediatric patients are more likely to develop AVM-associated epilepsy. We examined the role of multimodality AVM treatment in pediatric AVM-associated epilepsy to characterize long-term epilepsy outcomes.
Methods:
A retrospective chart review identified pediatric patients with AVM-associated epilepsy seen at our institution from 2005 to 2018. Variables measured included demographic and descriptive data. Primary outcomes included seizure freedom, seizure control, and functional outcomes.
Results:
Of 105 pediatric patients with AVMs, 18 had AVM-related epilepsy. Thirteen underwent surgical resection, of which 6 underwent preoperative embolization. Twelve (92.31%) had complete resection; one (7.69%) with residual underwent redo craniotomy with subsequent complete resection. All had radiographic cure at most recent follow-up, with no recurrence seen during length of follow-up (mean 2.17 years, SD 1.40, range 0.25-4.41). Eight (61.54%) experienced seizure freedom postoperatively; 12 (92.31%) were modified Engel Class I at last follow-up. Five patients underwent treatment without open surgical resection, with conservative management (3, 60%) or endovascular embolization (2, 40%). None in our cohort underwent radiosurgery. Of those embolized, one had complete AVM obliteration and two had partial obliteration. Four of the 5 patients (80%) treated without open surgery achieved seizure freedom.
Conclusion:
Long-term outcomes of AVM-related epilepsy are poorly characterized in children. We found that in addition to improved AVM outcomes regarding obliteration, treatment of residual, and recurrence, pediatric patients undergoing surgical AVM treatment had improved AVM-associated epilepsy outcomes, with 61.54% achieving seizure freedom and 92.31% classified as modified Engel Class I seizure control.
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