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Intracranial arteriovenous malformations in the pediatric age: experience with 24 cases
Insights
Direct surgical removal of pediatric intracranial arteriovenous malformations (AVMs) is the preferred treatment, offering good outcomes and improved epilepsy in most cases. This approach is recommended even when epilepsy is the sole presenting symptom.
Area of Science:
- Neurosurgery
- Pediatric Neurology
- Vascular Malformations
Background:
- Intracranial arteriovenous malformations (AVMs) in pediatric patients present significant challenges.
- Common initial symptoms include intracranial hemorrhage, epilepsy, and hydrocephalus.
Purpose of the Study:
- To evaluate the efficacy and outcomes of surgical resection for pediatric intracranial AVMs.
- To highlight the role of advanced imaging and surgical techniques in managing these complex lesions.
Main Methods:
- Retrospective analysis of 24 pediatric patients (<16 years) with intracranial AVMs.
- Preoperative evaluation using angiography and CT scans.
- Surgical resection with operative microscope, induced hypotension, and 'backward technique' in 18 cases.
Main Results:
- Complete surgical resection achieved in 18 patients; embolization in 1.
- Good outcomes reported in 83% of cases with an 11% mortality rate.
- Significant improvement in epilepsy observed post-surgery in most patients.
Conclusions:
- Direct surgical extirpation is the treatment of choice for pediatric intracranial AVMs.
- Surgical intervention is beneficial even when epilepsy is the primary presenting symptom.
- Advanced surgical techniques and preoperative imaging are crucial for successful management.
Abstract:
24 patients below 16 years of age with intracranial arteriovenous malformations are considered. Presenting history has been constituted mainly by intracranial hemorrhage, followed by epilepsy and hydrocephalus. The utility of angiography and CT scan is stressed, especially for preoperative evaluation. The arteriovenous malformation was located in noncritical cortical areas in 7 cases, in critical cortical areas in 6 cases, in the midline structures or in the basal ganglia in 8 cases, in the posterior fossa in 2 cases, and was only dural in 1 case. Complete surgical resection of the lesion has been carried out in 18 cases, and embolization in 1 case. The operative microscope, induced hypotension, and the 'backward technique' have been very useful during surgery. Following the operation, good results have been achieved in 83% of cases; mortality has been 11%. In most cases epilepsy has shown improvement after surgery. It is concluded that direct surgical extirpation of the angioma is the treatment of choice for pediatric patients, even in the presence of epilepsy alone.