Cerebral Arteriovenous Malformations in Children (56 Cases)

Gerosa, Massimo; Cappellotto, Paolo; Licata, Claudio; Iraci, G; Pardatscher, K.; Fiore, D.

doi:10.1159/000120000

Cited by 41 publications

(34 citation statements)

References 13 publications

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“…1,3,4,14,23,39 Pediatric patients with AVMs are more likely to present with hemorrhage than adults. 2,5,10,11 The annual risk of hemorrhage for untreated AVMs has been estimated to be 2%-4%, a mortality rate of 5%-10% after hemorrhage, and a 50% risk of severe morbidity associated with hemorrhage.…”

Section: Discussionmentioning

confidence: 99%

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Stereotactic radiosurgery for arteriovenous malformations, Part 2: management of pediatric patients

Kano

Kondziolka

Flickinger

et al. 2012

PED

101

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Object The authors conducted a study to define the long-term outcomes and risks of stereotactic radiosurgery (SRS) for pediatric arteriovenous malformations (AVMs). Methods Between 1987 and 2006, the authors performed Gamma Knife surgery in 996 patients with brain AVMs; 135 patients were younger than 18 years of age. The median maximum diameter and target volumes were 2.0 cm (range 0.6–5.2 cm) and 2.5 cm3 (range 0.1–17.5 cm3), respectively. The median margin dose was 20 Gy (range 15–25 Gy). Results The actuarial rates of total obliteration documented by angiography or MR imaging at 71.3 months (range 6–264 months) were 45%, 64%, 67%, and 72% at 3, 4, 5, and 10 years, respectively. The median time to complete angiographically documented obliteration was 48.9 months. Of 81 patients with 4 or more years of follow-up, 57 patients (70%) had total obliteration documented by angiography. Factors associated with a higher rate of documented AVM obliteration were smaller AVM target volume, smaller maximum diameter, and larger margin dose. In 8 patients (6%) a hemorrhage occurred during the latency interval, and 1 patient died. The rates of AVM hemorrhage after SRS were 0%, 1.6%, 2.4%, 5.5%, and 10.0% at 1, 2, 3, 5, and 10 years, respectively. The overall annual hemorrhage rate was 1.8%. Larger volume AVMs were associated with a significantly higher risk of hemorrhage after SRS. Permanent neurological deficits due to adverse radiation effects developed in 2 patients (1.5%) after SRS, and in 1 patient (0.7%) delayed cyst formation occurred. Conclusions Stereotactic radiosurgery is a gradually effective and relatively safe management option for pediatric patients in whom surgery is considered to pose excessive risks. Although hemorrhage after AVM obliteration did not occur in the present series, patients remain at risk during the latency interval until obliteration is complete. The best candidates for SRS are pediatric patients with smaller volume AVMs located in critical brain regions.

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Section: Discussionmentioning

confidence: 99%

“…2,5,11 Several authors report that an initial hemorrhagic presentation varies from 38% to 45% of their patients. 7,40 In the present study, 64% of our pediatric patients with AVMs had a history of hemorrhage.…”

Section: Hemorrhage After Srsmentioning

confidence: 99%

Stereotactic radiosurgery for arteriovenous malformations, Part 2: management of pediatric patients

Kano

Kondziolka

Flickinger

et al. 2012

PED

101

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“…In 15% to 30% of the cases, seizures are the first clinical manifestations. 11,12 A relationship between the type of initial presentation and the size of the AVM has been described, the small AVMs manifesting themselves by strokes and the large ones by seizure. 1 Deeply comatose children could represent 50% of the cases in the particular entity of cerebellar hemorrhages.…”

Section: Discussionmentioning

confidence: 99%

Emergency management of deeply comatose children with acute rupture of cerebral arteriovenous malformations

Meyer

Orliaguet

Zérah

et al. 2000

Can J Anesth/J Can Anesth

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REPORTS O F INVESTIGATIONCAN J ANESTH 2000 / 47: 8 / pp [758][759][760][761][762][763][764][765][766] Purpose: To assess the impact of emergency management on mortality and morbidity of acute rupture of cerebral arteriovenous malformations resulting in deep coma in children, and the factors predicting outcome. Methods: Retrospective chart review of 20 children with a Glasgow Coma Scale # 8 with acute hemorrhagic stroke from a cerebral arteriovenous malformation rupture was conducted. Protocol included: early resuscitation with tracheal intubation and ventilation after induction of anesthesia with sufentanil, and benzodiazepine, and mannitol 20% or hypertonic saline 7.5% infusion for life-threatening brain herniation. Radiological exploration was limited to contrast-enhanced CT scan preceding immediate surgical decompression. Postoperatively, children were deeply sedated and intracranial pressure monitoring allowed titration with osmotherapy , vasopressors, hyperventilation or barbiturate coma to control cerebral perfusion pressure. Analysis used stratification of the type of hemorrhage (supra or infra tentorial), location (intraparenchymal and subarachnoid, intraparenchymal and intraventricular or intraventricular alone) and relationship between presentation, evolution with resuscitation, type of cerebral lesion, and outcome. Results: Patients had a severe initial presentation (median Glasgow Coma Scale five), eight had unilateral and eight bilateral third nerve palsy. Compressive hematoma in supratentorial localisation represented 75% of the cases. Global mortality was 40%. Persistence of mydriasis after resuscitation increased mortality to 75%. Massive intraventricular flooding was associated with increased mortality. Good functional outcome was achieved in survivors. Conclusion: Acute rupture of an AVM can result in rapidly progressing coma. Emergency management with early resuscitation, minimal radiological exploration before rapid surgical decompression results in a mortality rate of 40%, but a good functional outcome can be expected in the survivors.Objectif : Évaluer l'effet et le pronostic d'une intervention d'urgence sur la mortalité et la morbidité d'une rupture imprévisible de malformations artérioveineuses cérébrales qui ont conduit à un coma profond chez des enfants. Méthode : Un examen rétrospectif des dossiers de 20 enfants, cotés # 8 à l'échelle de Glasgow, qui ont subi un accident hémorragique aigu causé par la rupture de malformations artérioveineuses cérébrales, a été réalisé. Le protocole comportait : une réanimation précoce, une intubation endotrachéale et une ventilation après l'induction de l'anesthésie avec du sufentanil, du mannitol à 20 % ou une perfusion salée hypertonique à 7,5 % pour traiter l'hernie cérébrale grave. L'exploration radiologique s'est limitée à la scanographie de prise de contraste juste avant la décompression chirurgicale. Après l'opération, les enfants ont reçu une forte sédation. Le monitorage de la pression intracrânienne a permis le titrage de l'osmothérapie, des ...

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“…There is a high propensity (80%) for the AVM childhood to present bleeding 8 , what is higher than that reported for adults 9,[15][16][17] . Likewise, epilepsy was reported in 12-18%of the AVM` s children series 7,18 and in 16 to 53% of the adult patients 19,20 . In neonates, AVM has been recognized as a cause of life-threatening congestive heart failure 21 .…”

Section: Discussionmentioning

confidence: 92%

“…Several authors have reported that the prognosis was not so good in children with AVM in comparison to adults 7,18,22 . Conversely, a better prognosis was suggested for purely intraventricular haemorrhage arteriovenous malformation as observed in our patient by some reports 23 .…”

Section: Discussionmentioning

confidence: 96%

Ventricular arteriovenous malformation bleeding: a rare cause of headache in children. Case report

Silva¹,

Silva

Paschoal

et al. 2004

Arq. Neuro-Psiquiatr.

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-Headache as a chief complaint is rare in the paediatric emergency room.Actually, very seldom cases secondary to life threatening conditions as non-traumatic subarachnoid haemorrhage have been reported. A child with severe headache and nuchal rigidity and no other abnormalities on the physical examination is reported. Magnetic resonance angiography and cerebral angiography disclosed a ventricular arteriovenous malformation in the choroid plexus, supplied by the anterior choroidal artery, classified according to Spetzler grading system as grade 3 (deep venous drainage: 1; eloquence area: 0 and size: 2).The differences in the clinical presentations of the central nervous system arteriovenous malformation between children and adults are discussed.KEY WORDS: secondary headache in children, arteriovenous malformation of the brain, pediatric stroke. Hemorragia cerebral secundária a malformação artério-venosa ventricular: uma causa rara de cefaléia na infân-cia. Relato de casoRESUMO -Cefaléia como queixa principal raramente ocorre num serviço de emergência pediátrica. Quando isso acontece, casos de cefaléia secundária que trazem risco de vida, tais como a hemorragia subaracnóide são raramente relatados. Apresentamos o caso de uma criança que apresentou cefaléia de forte intensidade associada a rigidez de nuca, sem outras anormalidades no exame físico. A angioressonância e angiografia digital evidenciaram malformação arteriovenosa na topografia do plexo coróide do ventrículo lateral direito, nutrida pela artéria coroidéia anterior, grau III na classificação de Spetzler (drenagem venosa profunda: 1; área de eloqüência: 0 e tamanho: 2). Nós discutimos as diferenças na apresentação clínica das malformações arteriovenosas encefálicas nas crianças e adultos. PALAVRAS-CHAVE: cefaléia secundária, malformação arteriovenosa do encéfalo, malformação arteriovenosa ventricular.A headache due to a hemorrhagic stroke is a life-threatening clinical condition rarely seen in a paediatric emergency department 1,2 .When it occurs, an arteriovenous malformation should be ruled out. The arteriovenous malformation of the brain (AVM) accounts for 30% to 50% of such hemorrhagic strokes in children [3][4][5][6] and it has been associated with a 25% mortality rate 7 . On the other hand, the ventricular location is found in only 4% of the AVM in childhood 8 ; and in 1,3% of the adult's AVM 9 . We report a child with a history of sudden headache secondary to a bleeding of a ventricular arteriovenous malformation. CASEA 9-year-old previously healthy girl was admitted to the Emergency Room with an eight-hour history of sudden onset of severe headache. The pain was pulsatile and bilateral and not accompanied by other symptoms. There is no history of migraine, epilepsy or stroke. Parents reported that soon after the onset of the headache the patient

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Cerebral Arteriovenous Malformations in Children (56 Cases)

Cited by 41 publications

References 13 publications

Stereotactic radiosurgery for arteriovenous malformations, Part 2: management of pediatric patients

Stereotactic radiosurgery for arteriovenous malformations, Part 2: management of pediatric patients

Emergency management of deeply comatose children with acute rupture of cerebral arteriovenous malformations

Ventricular arteriovenous malformation bleeding: a rare cause of headache in children. Case report

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