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Three-Pillar Expansive Craniotomy in Children with Acute Ruptured Supratentorial Brain Arteriovenous Malformations
Tianquan Yang1, Yuchen Liu1, Bin Yuan1
1Department of Neurosurgery, Children's Hospital of Soochow University, Suzhou, Jiangsu, China.
Insights
Three-pillar expansive craniotomy (3PEC) is a feasible emergency intervention for pediatric ruptured brain arteriovenous malformations (AVMs). This surgical approach effectively reduces intracranial pressure and may lower rebleeding risk in delayed treatment cases.
Area of Science:
- Neurosurgery
- Pediatric Neurology
- Vascular Malformations
Background:
- Acute rupture of pediatric brain arteriovenous malformations (AVMs) can cause severe complications like cerebral herniation and intracranial hypertension.
- The optimal timing for treating ruptured pediatric AVMs remains a subject of debate.
- Surgical interventions are crucial for managing elevated intracranial pressure.
Purpose of the Study:
- To evaluate the feasibility of three-pillar expansive craniotomy (3PEC) in treating pediatric supratentorial AVMs at various stages.
- To assess the safety and efficacy of 3PEC in managing acute rupture and hemorrhage of pediatric AVMs.
Main Methods:
- Retrospective analysis of pediatric patients with acutely ruptured supratentorial AVMs treated with 3PEC between 2020 and 2022.
- Review of general information, clinical characteristics, radiological data, and patient outcomes.
- Comparison of cranial cavity expansion volume with hematoma volume.
Main Results:
- Thirteen pediatric patients were included in the study.
- Intracranial pressure decreased below 15 mmHg within 10 days for all patients.
- Cranial cavity expansion averaged 18.3 cm³ greater than hematoma volume, with no need for decompressive craniectomy.
- No rebleeding occurred during a median waiting period of 8 days for delayed treatment.
Conclusions:
- Emergency 3PEC is a feasible surgical option for children with acutely ruptured supratentorial AVMs.
- 3PEC may reduce rebleeding risk and shorten waiting times for patients requiring delayed AVM management.
Objective:
Acute rupture and hemorrhage of pediatric brain arteriovenous malformations (AVMs) may lead to cerebral herniation or intractable intracranial hypertension, necessitating emerging surgical interventions to alleviate intracranial pressure. However, there is still controversy regarding the timing of treatment for ruptured AVMs. This study aimed to assess the feasibility of utilizing three-pillar expansive craniotomy (3PEC) at different times during the treatment of pediatric ruptured supratentorial AVMs.
Methods:
A retrospective analysis was conducted on all consecutive cases of acute rupture in supratentorial AVM children who underwent 3PEC at a single institution from 2020 to 2022. General information, clinical characteristics, radiological data, and prognosis were reviewed and analyzed.
Results:
Thirteen children were included in the analysis. The intracranial pressure of all patients decreased to below 15 mmHg within 10 days. The expansion volume of the cranial cavity of the patients increased by 18.3 cm3 (95% confidence interval, 10.2-26.3; P < 0.001) compared to the hematoma volume. None of the patients required decompressive craniectomy due to intractable intracranial hypertension caused by cerebral swelling. The median waiting period for patients with delayed AVMs treatment was 8 days, during which no rebleeding occurred.
Conclusions:
Emergency intervention with 3PEC in children experiencing acutely ruptured supratentorial AVMs appears to be feasible. For children requiring delayed management of the AVMs, 3PEC may diminish the risk of rebleeding during the waiting period and shorten the waiting period.
