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Long-Term Outcomes of Pediatric Cerebral Arteriovenous Malformations: A Ten-Year Single-Center Retrospective Study
Mei-Cheng Hsiao1, Yuang-Seng Tsuei1,2,3, Hung-Chuan Pan1,4
1Department of Neurosurgery, Neurological Institute, Taichung Veterans General Hospital, Taichung 407, Taiwan.
Insights
Pediatric cerebral arteriovenous malformations (AVMs) have high risks. Both surgical resection and stereotactic radiosurgery (SRS) offer effective treatment options for pediatric AVMs, with microsurgery showing high obliteration rates.
Area of Science:
- Pediatric Neurosurgery
- Vascular Neurology
- Radiation Oncology
Background:
- Pediatric cerebral arteriovenous malformations (AVMs) pose significant risks of morbidity and mortality.
- Effective long-term treatment strategies for pediatric cerebral AVMs are crucial.
Purpose of the Study:
- To evaluate and compare the long-term outcomes of surgical excision versus stereotactic radiosurgery (SRS) for pediatric cerebral AVMs.
- To assess the efficacy and safety of these treatment modalities in a pediatric population.
Main Methods:
- A retrospective analysis of 45 pediatric patients with cerebral AVMs treated between January 2012 and July 2022.
- Evaluation of Modified Rankin Scale (mRS) and Spetzler-Martin (SM) scores, alongside treatment outcomes (obliteration rates, complications).
Main Results:
- Surgical resection in 19 patients achieved complete obliteration in all cases with good outcomes (mRS 0-2) for 16 patients.
- Stereotactic radiosurgery (SRS) in 26 patients resulted in 69.2% complete obliteration after an average of 36.3 months, with all patients experiencing favorable outcomes (mRS 0-1) and no complications.
Conclusions:
- Both surgical resection and SRS are effective treatment options for pediatric cerebral AVMs, with outcomes tailored to individual patient conditions.
- Microsurgical resection demonstrates a high obliteration rate and is a favorable therapeutic choice for pediatric AVMs, offering acceptable risks.
Abstract:
Background and Objectives: Pediatric cerebral arteriovenous malformations (AVMs) are associated with significant morbidity and mortality. The aim of this study was to assess the long-term outcomes of surgical excision and stereotactic radiosurgery (SRS) of cerebral AVMs in pediatric patients. Materials and Methods: A single-center retrospective analysis was conducted using data obtained from a single medical center between January 2012 and July 2022. The Modified Rankin Scale (mRS) at admission and discharge and the Spetzler-Martin (SM) scores were analyzed. Results: Among 45 patients (mean age 11.8 years), 19 patients (42.2%) received surgical resection, with good outcomes (mRS 0-2) in 16 patients and complete obliteration in all patients. In total, 26 patients (57.8%) were managed with SRS. After 36.3 months on average, complete obliteration in 19 of 26 patients (69.2%) was confirmed. Among the 7 SRS patients without complete obliteration, 6 had residual cerebral AVMs at the last follow-up, and 1 had recurrence. All patients receiving SRS had favorable outcomes (mRS 0-1) and no apparent radiosurgery-related complications. Conclusions: In our study, the surgical resection or SRS was selected based on individual patient conditions, and the overall outcomes were satisfactory. Both surgical resection and SRS proved to be effective treatment options. Microsurgical resection demonstrated a high rate of obliteration and remains a favorable therapeutic choice with acceptable risks for pediatric AVMs.
