Cerebral arteriovenous malformations in children and adolescents

A series of 19 juveniles with cerebral arteriovenous malformations is reported. The group is composed of 8 children and 11 adolescents, aged 9-18 years, with an average age of 14.5 years. There were 10 males and 9 females. Twelve juveniles were treated by operation. Ten patients were operated upon electively; one of these died as a direct consequence of excision of the arteriovenous malformation--a female patient with an arteriovenous malformation of the corpus callosum. One other patient in this category expired 3.5 months after the removal of the arteriovenous malformation, from unrelated infectious complications arising from a preoperational ventriculo-peritoneal shunting procedure. Two patients were operated upon on an emergency basis because of an associated intraparenchymal hematoma; both of these patients died. All surgical survivors are leading independent lives. The postoperative observation period ranges from 6 months to more than 17.5 years, with an average of 6.6 years. Of the seven patients treated by nonsurgical means, one was hospitalized in a coma after rupture of the arteriovenous malformation and died shortly after admission; another--a girl in the fifth month of her first pregnancy--was admitted in a stupor and expired from a recurrent subarachnoid hemorrhage 3 weeks after the first occurrence. Five nonsurgical patients left the hospital in good condition, but one died at home 2 years later from intractable cardiorespiratory insufficiency associated with an aneurysm of the vein of Galen.