Timing of Embolization, Radiosurgery, and Resection of Arteriovenous Malformations in Pediatric Patients: A
Gabriel Flores-Milan1, Gersham J Rainone1, Ivo Peto1
1Department of Neurosurgery and Brain Repair, University of South Florida, Tampa, Florida, USA.
Insights
Early treatment of pediatric cerebral arteriovenous malformations (AVMs) appears safe and effective. This study highlights the timing of multimodal therapy for pediatric AVMs, showing good outcomes regardless of rupture status.
Area of Science:
- Neurology
- Neurosurgery
- Pediatric Medicine
Background:
- Cerebral arteriovenous malformations (AVMs) pose significant risks in pediatric patients.
- Current treatment strategies lack consensus on optimal timing and modality.
- The timing of multimodal therapy for pediatric AVMs requires further investigation.
Purpose of the Study:
- To evaluate the safety and efficacy of treatment timing for pediatric cerebral AVMs.
- To analyze outcomes based on the timing of intervention in relation to AVM rupture.
- To provide insights into the management of pediatric AVMs.
Main Methods:
- Retrospective review of electronic medical records for pediatric patients (<18 years) with AVMs.
- Data collection included demographics, AVM characteristics, treatment variables, and patient outcomes.
- Institutional Review Board approval was obtained prior to data review.
Main Results:
- The cohort comprised 27 pediatric patients with AVMs; 77.8% presented with rupture.
- Patients with ruptured AVMs and low Glasgow Coma Scale scores were treated within 24 hours.
- Overall, 96% of patients achieved a modified Rankin Scale score of 1-2 at follow-up, indicating favorable outcomes.
Conclusions:
- Early intervention for pediatric AVMs is a safe and effective strategy.
- Treatment timing does not appear to negatively impact outcomes, irrespective of rupture status.
- This study contributes to understanding optimal management strategies for pediatric AVMs.
Objective:
Cerebral arteriovenous malformations (AVMs) are a challenging pathology in pediatric patients, carrying a high risk of morbidity and mortality. Treatment modalities include resection, endovascular embolization, and stereotactic radiosurgery. There is currently no consensus favoring one modality over another. Timing of multimodal therapy with embolization/stereotactic radiosurgery and resection is not well explored in the literature. We present a series of pediatric patients with AVMs, with special attention directed to the timing of treatment.
Methods:
Electronic medical records of all pediatric patients (<18 years old at treatment) with AVMs treated at our institution were retrospectively reviewed after institutional review board approval. Demographic information, AVM characteristics, treatment variables, and outcomes were recorded.
Results:
In our cohort of 27 patients, 21 (77.8%) presented with a ruptured AVM. Of these patients, 6 (28.6%) had a Glasgow Coma Scale score of 3-10 and underwent treatment within 24 hours of presentation, and 10 (47.6%) with a Glasgow Coma Scale score of 12-15 were treated between 24 and 120 hours after presentation. The remaining 5 patients (23.8%) were treated 3 weeks to 14 months after AVM rupture. Regardless of rupture status, 96% of our cohort had a modified Rankin Scale score of 1-2 at most recent follow-up.
Conclusions:
We present our institution's experience with pediatric AVMs, focusing on the timing of treatment. Based on our experience, early treatment of AVMs seems to be safe and effective regardless of rupture status.
