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Comprehensive Endovascular and Open Surgical Management of Cerebral Arteriovenous Malformations
Published on: October 20, 2017
Unruptured cerebral arteriovenous malformation in children: Outcome in treated and untreated patients
Matthieu Vinchon1, Amelie Toubol1, Melodie-Anne Karnoub1
1Neurosurgery Clinic, Lille University Hospital, Lille, France.
Insights
Treatment for pediatric unruptured cerebral arteriovenous malformations (URCAVM) is a viable option, offering better outcomes than observation. Microsurgery provides the best results when feasible for URCAVM management in children.
Area of Science:
- Pediatric Neurology
- Neurosurgery
- Vascular Neurology
Background:
- Management of unruptured cerebral arteriovenous malformations (URCAVM) remains controversial.
- Limited data exists on URCAVM specifically in pediatric populations.
Purpose of the Study:
- To evaluate the outcomes of observation versus treatment for pediatric URCAVM.
- To compare different treatment modalities for pediatric URCAVM.
Main Methods:
- Retrospective review of pediatric patients with URCAVM from 2001-2021.
- Analysis of management strategies including observation, microsurgery, radiosurgery, embolization, and combined treatments.
- Assessment of clinical outcomes, including cure rates, neurological deficits, and symptom improvement.
Main Results:
- Of 36 patients, 12 were observed and 24 received treatment.
- Complete cure was achieved in 58% of the treatment group (14/24), with microsurgery showing 100% efficacy (8/8).
- Two observed patients experienced cerebral hemorrhage, while 1/5 neurological deficits in the treatment group was significant; headache improved in 11 patients.
Conclusions:
- Treatment for pediatric URCAVM is a reasonable consideration due to hemorrhage risk and symptoms.
- Microsurgery offers superior functional results and AVM control when technically feasible.
- Individualized risk-benefit assessment is crucial for treatment decisions in pediatric URCAVM.
Background:
The management of unruptured cerebral arteriovenous malformation (URCAVM) is highly controversial; however, data regarding URCAVM in children are scarce.
Material And Methods:
We retrospectively reviewed consecutive children followed for URCAVM in our department between 2001 and 2021.
Results:
Out of 36 patients, 12 were initially managed by observation, and 24 underwent first-line treatment: 8 by microsurgery, 10 by radiosurgery, 2 by embolization, and 4 by combined treatment. Mean follow-up of the whole group was 63months. Complete cure of the malformation was obtained in 14 patients (58%) in the treatment group: 8/8 in the microsurgery group, 5/10 in the radiosurgery group, 1/4 in the combined treatment group, and none in the embolization group. Two of the initially non-treated patients presented cerebral hemorrhage, with significant neurological consequences. In the treatment group, 5 patients presented new neurological deficits, only 1 of which, however, was functionally significant. Headache improved in 11 cases, mostly in the treatment group. Overall, 6 patients in the treatment group became asymptomatic, versus none in the observation group.
Conclusions:
The treatment of URCAVM is a reasonable option in many pediatric cases, considering the cumulative risk of cerebral hemorrhage during the child's lifetime, as well as the symptoms specific to URCAVM. Microsurgery, when feasible, offers the best functional results and control of the AVM; however, the risk-benefit ratio should be weighed on a case-by-case basis. More studies will be needed to inform treatment decisions in pediatric URCAVM.
