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Comprehensive Endovascular and Open Surgical Management of Cerebral Arteriovenous Malformations
Published on: October 20, 2017
Delayed recurrence of pediatric arteriovenous malformations after radiologically confirmed obliteration
Soliman Oushy1, Hannah E Gilder1, Cody L Nesvick1
1Departments of1Neurologic Surgery.
Insights
Pediatric arteriovenous malformation (AVM) recurrence after obliteration is rare but occurs more often in children than adults. Long-term surveillance imaging, including angiography, is recommended for pediatric AVM patients post-treatment.
Area of Science:
- Neurology
- Pediatric Neurosurgery
- Vascular Malformations
Background:
- Arteriovenous malformations (AVMs) are a significant cause of intracerebral hemorrhage in children, associated with high morbidity and mortality.
- Pediatric AVMs (pAVMs) exhibit a higher recurrence rate compared to adult AVMs.
Purpose of the Study:
- To determine the risk of delayed pAVM recurrence after confirmed radiological obliteration.
- To inform the necessity and frequency of long-term radiological surveillance for pediatric AVMs.
Main Methods:
- Retrospective review of 102 pediatric patients with intracranial AVMs treated between 1994 and 2019.
- Analysis of demographics, clinical data, treatment modalities, and AVM recurrence rates.
- Focus on cases with confirmed radiological obliteration and long-term follow-up imaging.
Main Results:
- AVM recurrence was identified in 1 out of 43 patients (2.3%) with long-term surveillance (mean follow-up 54.7 months).
- The single recurrence case involved a ruptured AVM treated surgically in a 5-year-old boy, recurring 54 months post-obliteration.
- Confirmed obliteration rates were 72.3% based on available follow-up imaging.
Conclusions:
- Delayed AVM recurrence after confirmed obliteration is uncommon in children but more frequent than in adults.
- Regular, long-term surveillance with dedicated angiography is advised for pediatric AVM patients even after successful obliteration.
Objective:
Arteriovenous malformations (AVMs) are a major cause of intracerebral hemorrhage in children, resulting in significant morbidity and mortality. Moreover, the rate of AVM recurrence in children is significantly higher than in adults. The aim of this study was to define the risk of delayed pediatric AVM (pAVM) recurrence following confirmed radiological obliteration. Further understanding of this risk could inform the role of long-term radiological surveillance.
Methods:
The authors conducted a retrospective review of ruptured and unruptured pAVM cases treated at a single tertiary care referral center between 1994 and 2019. Demographics, clinical characteristics, treatment modalities, and AVM recurrence were analyzed.
Results:
A total of 102 pediatric patients with intracranial AVMs, including 52 (51%) ruptured cases, were identified. The mean patient age at presentation was 11.2 ± 4.4 years, and 51 (50%) patients were female. The mean nidus size was 2.66 ± 1.44 cm. The most common Spetzler-Martin grades were III (32%) and II (31%). Stereotactic radiosurgery was performed in 69.6% of patients. AVM obliteration was radiologically confirmed in 68 (72.3%) of 94 patients with follow-up imaging, on angiography in 50 (73.5%) patients and on magnetic resonance imaging in 18 (26.5%). AVM recurrence was identified in 1 (2.3%) of 43 patients with long-term surveillance imaging over a mean follow-up of 54.7 ± 38.9 months (range 2-153 months). This recurrence was identified in a boy who had presented with a ruptured AVM and had been surgically treated at 5 years of age. The AVM recurred 54 months after confirmed obliteration on surveillance digital subtraction angiography. Two other cases of presumed AVM recurrence following resection in young children were excluded from recurrence analysis because of incomplete sets of imaging available for review.
Conclusions:
AVM recurrence following confirmed obliteration on imaging is a rare phenomenon, though it occurs more frequently in the pediatric population. Regular long-term follow-up with dedicated surveillance angiography is recommended even after obliteration following resection.
