Multimodal management of pediatric brain arteriovenous malformations: single-center experience from a retrospective...

Intracranial arteriovenous malformations (AVMs) are a major cause of intracranial hemorrhage (ICH) in children, often leading to significant neurological deficits or mortality. The primary aim of this study was to analyze the management strategies and long-term outcomes of pediatric AVMs treated at Santobono-Pausilipon Children's Hospital over the past 15 years with a particular focus on hemorrhagic presentation.

A retrospective review was conducted on pediatric patients (0-18 years) diagnosed with intracranial AVMs between July 2008 and December 2024. Data on demographics, clinical presentation, imaging findings, Spetzler-Martin and Supplemented Spetzler-Martin grading, treatment modalities, complications, and outcomes were collected. Treatment approaches included microsurgical resection, endovascular embolization, stereotactic radiosurgery (SRS), and multimodal management were evaluated.

A total of 48 pediatric AVM cases were identified (24 males, 24 females; mean age: 8.8 years). The majority (N.=41, 85.4%)) presented with intracranial hemorrhage. Treatment strategies included microsurgical resection (17 cases), embolization (6 cases), SRS (9 cases), and multimodal therapy (14 cases). Mean follow-up was 5 years. Residual AVMs were detected in 13% of cases, with three rebleeding events. The postoperative modified Rankin Scale (mRS) showed favorable outcomes (mRS 0-2) in 37 patients. One patient died due to major hemorrhage.

Pediatric AVMs exhibit diverse clinical presentations and require individualized management strategies. While surgical resection remains the most definitive treatment, multimodal approaches may be necessary for high-grade or deep-seated AVMs. Long-term follow-up is crucial due to the risk of AVM recurrence and rebleeding. Advancements in molecular and genetic research may further refine therapeutic strategies for pediatric AVMs in the future.