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Paediatric Cerebral Arteriovenous Malformation: Outcomes from a Singapore Children's Hospital
Jia Xu Lim1, Tien Ming Cheong2, Lee Ping Ng1
1Neurosurgical Service, KK Women's and Children's Hospital, 100 Bukit Timah Road, 229899 Singapore.
Insights
Pediatric brain arteriovenous malformations (bAVMs) can be effectively managed with monomodal therapies. Extended surveillance is crucial for detecting recurrences in young patients.
Area of Science:
- Pediatric Neurosurgery
- Cerebrovascular Disorders
- Neurology
Background:
- Pediatric brain arteriovenous malformation (bAVM) is a rare neurological condition.
- Multimodality treatment approaches are increasingly recognized for managing bAVMs.
Purpose of the Study:
- To describe institutional experience in managing pediatric bAVMs.
- To evaluate the effectiveness of monomodal therapies and identify factors influencing recurrence.
Main Methods:
- Retrospective single-institution study over 20 years.
- Inclusion of pediatric patients (<19 years) with bAVM.
- Analysis of demographics, clinical presentation, imaging, treatment, and outcomes (modified Rankin Scale).
Main Results:
- 58 pediatric bAVMs treated, mean age 8.7 years.
- Microsurgical resection (62.1%) and stereotactic radiosurgery (17.2%) were primary treatments.
- 86.2% favorable outcomes at 1 year; similar obliteration and recurrence rates for resection and SRS.
- Younger age (<7.5 years) at presentation was associated with recurrence.
Conclusions:
- Monomodal therapy can be effective for pediatric bAVMs.
- Extended surveillance is important for detecting bAVM recurrence in children.
- Understanding recurrence factors aids in optimizing treatment and follow-up strategies.
Objectives:
Paediatric brain arteriovenous malformation (bAVM) is a rare and distinct clinical entity. There is a growing body of literature that support the success of multimodality approaches for this difficult condition. The authors aim to firstly, describe our institutional experience with a consecutive series of patients and next, corroborate our results with current literature.
Material And Methods:
This is a single institution, retrospective study conducted over a 20-year period. Patients less than 19 years old with bAVM were included. Variables of interest included patient demographics, clinical presentation, neuroimaging features, bAVM characteristics and treatment modality. Functional outcomes were measured with modified Rankin scale (mRS).
Results:
There were 58 paediatric bAVMs, presenting at a mean age of 8.7 ± 4.2 years, and followed up for a mean duration of 7.7 years. Thirty-six patients (62.1%) underwent microsurgical resection, 10 patients had stereotactic radiosurgery (17.2%) and 2 patients had endovascular treatment (3.4%). 50 patients (86.2%) had a favourable outcome at 1-year follow up. Microsurgical resection and SRS had similar obliteration rates (resection 83.3%; SRS 80.0%) and recurrence (resection 10.0%; SRS 12.5%). There were 6 cases of bAVM recurrence (12.8%). This subgroup was noted to be less than 7.5 years old at presentation (OR 15.0, 95% CI 1.56 - 144), and less likely to present with bAVM rupture (OR 0.11, 95% CI 0.01 - 0.96).
Conclusion:
This study describes our experience in managing paediatric bAVM, whereby monomodal therapy can still be effective. Of note, we also demonstrate the role of extended surveillance to detect recurrence.