Surgical management of arteriovenous malformations in children

Ruth E. Bristol, Felipe C. Albuquerque, Robert F. Spetzler, Harold L. Rekate, Cameron G. McDougall, Joseph M. Zabramski

Research output: Contribution to journalArticlepeer-review

Abstract

Object. Children compose 3 to 20% of the patients with arteriovenous malformations (AVMs); however, AVMs are responsible for 30 to 50% of intracranial hemorrhages in children. Methods. The medical records of 82 children with 84 AVMs treated surgically between 1983 and 2005 were reviewed. Fifty-two patients (63%) presented with hemorrhage, 13.4% presented with seizures, and AVMs in 12% were found incidentally. Patients with brainstem lesions presented at a significantly younger age (p = 0.002) than those harboring lesions in other locations. Frontal lobe lesions were significantly smaller than those in other locations, and thalamic lesions were significantly larger (p = 0.012 and 0.005, respectively). Most patients with Spetzler-Martin Grades I to III lesions underwent craniotomy only. Half of the patients with Grade IV and V lesions underwent embolization, craniotomy, and radiosurgery. The mean follow-up period was 43 months. Postoperatively, the initial obliteration rate was 65%, with a long-term obliteration rate of 90%. The perioperative mortality rate was 3.7%. Altogether, 81% of patients had excellent outcomes, and patients with Grade I lesions had the best outcomes. Of the 52 patients who presented with hemorrhage, 17% had fair or poor outcomes. The recurrence rate was 5.6%. Conclusions. Children with AVMs may be more prone than adults to present with a hemorrhage and to experience recurrence of the lesion after treatment. The authors favor resection for most AVMs in children and use embolization as a preoperative strategy for Grades II to V lesions treated surgically. Prehemorrhagic Grade IV and V lesions may best be treated conservatively and observed carefully for the development of symptoms. Long-term follow up of all patients is essential.

Original languageEnglish (US)
Pages (from-to)88-93
Number of pages6
JournalJournal of neurosurgery
Volume105 PEDIATRICS
Issue numberSUPPL. 2
DOIs
StatePublished - Aug 1 2006
Externally publishedYes

Keywords

  • Arteriovenous malformation
  • Cerebral hemorrhage
  • Pediatric neurosurgery
  • Stroke

ASJC Scopus subject areas

  • Surgery
  • Clinical Neurology

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