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Cerebral arteriovenous malformations in children
C Millar1, B Bissonnette, R P Humphreys
1Department of Anaesthesia, Hospital for Sick Children, University of Toronto, Ontario, Canada.
Summary
Treating pediatric cerebral arteriovenous malformations (AVM) is complex, with high risks. Early recognition and a multidisciplinary approach are crucial for managing these challenging neurosurgical cases and improving outcomes.
Area of Science:
- Neurosurgery
- Pediatric Anesthesiology
- Vascular Neurology
Background:
- Cerebral arteriovenous malformations (AVM) present unique challenges in pediatric neurosurgery.
- Large AVMs are rare in children, with only 18% symptomatic before age 15.
- Presentation varies, including hemorrhage (50%), seizures/hydrocephalus (36%), and congestive heart failure (18%).
Purpose of the Study:
- To review institutional experience with pediatric cerebral AVM from 1982-1992.
- To analyze presentation, management, and outcomes of these cases.
- To highlight the importance of a multidisciplinary approach and specialized anesthesia.
Main Methods:
- Retrospective review of pediatric cerebral AVM cases treated between 1982 and 1992.
- Analysis of clinical presentation, radiological findings (CT, MRI, angiography), and therapeutic interventions.
- Evaluation of operative complications, morbidity, and mortality rates.
Main Results:
- Congestive heart failure predominated in newborns; neurological symptoms in older children.
- Approximately one-third of pediatric AVMs presented acutely.
- Operative intervention carried significant risks, with over 50% experiencing peroperative complications.
- Overall mortality in the series was 20%, particularly high in neonates with cardiac failure.
Conclusions:
- Pediatric cerebral AVM management demands a multidisciplinary strategy.
- Anesthesia for embolization or surgical resection requires expertise in pediatric and neuroanesthesia.
- Attention to detail in anesthetic management is vital to reduce high morbidity and mortality.