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Pediatric subarachnoid hemorrhage is often caused by arteriovenous malformations. Incomplete surgical removal of these malformations, including the surrounding vascular nidus, can lead to re-bleeding years later.
Area of Science:
- Pediatric Neurology
- Neurosurgery
- Vascular Malformations
Background:
- Subarachnoid hemorrhage (SAH) in children presents unique challenges.
- Arteriovenous malformations (AVMs) and intracerebral hematomas are primary causes of pediatric SAH.
- Understanding the natural history and surgical outcomes of pediatric SAH is crucial.
Observation:
- A survey of 45 pediatric SAH cases revealed AVMs and hematomas as the cause in 73%.
- Pediatric AVMs can enlarge due to surrounding abnormal vascular groups, termed the 'reserved nidus'.
Findings:
- Failure to excise the reserved nidus during AVM surgery can result in later rebleeding.
- Surgical outcomes for subarachnoid hemorrhage in children were generally positive.
Implications:
- Complete surgical excision of AVMs, including the reserved nidus, is crucial for preventing recurrence.
- Understanding AVM growth dynamics is key to improving long-term pediatric SAH management.
Abstract:
45 cases of subarachnoid hemorrhage in children were surveyed. 73 percent of the causes were arteriovenous malformations and spontaneous intracerebral hematomata. Arteriovenous malformations in children may grow in size which may be due to the fact that besides the nidus demonstrated by angiography there are surrounding abnormal vascular groups, the reserved nidus. If one fails to extirpate this reserve nidus at the time of surgical excision of the arteriovenous malformation, it may become nidus several years later and may bleed again. The follow-up results of surgery in subarachnoid hemorrhage cases were fairly good.