Cerebral Arteriovenous Malformations in Children

Abstract

The treatment of cerebral arteriovenous malformations (AVM) or vascular anomalies are challenging neurosurgical procedures for an anaesthetist. Large AVMs are uncommon in children. Only 18% of AVMs become symptomatic before the age of 15 yr. This series reviews the experience at this institution during the period of 1982 to 1992. The symptoms at the time of presentation are varied and include haemorrhage (50%), seizures and hydrocephalus (36%) or congestive cardiac failure (18%). Symptoms of congestive heart failure predominate in the newborn whilst neurological symptoms, such as stroke, seizures or hydrocephalus occur more commonly in infants and older children. Approximately one third of AVMs in childhood present acutely. Radiological investigations., e.g., CT scan, MRI and cerebral angiography are essential to identify the precise location of the lesion. Therapeutic intervention in the acute presentation may involve eraniotomy for evacuation of haematoma and treatment of increased intracranial pressure (ICP). Control of seizures and congestive heart failure may take priority and allow time to plan the elective procedures of embolization and surgical excision of the AVM. Operative intervention is hazardous and peroperative complications can be expected in more than 50% of patients. The morbidity and mortality associated with cer-ebral AVM are high, especially in infants who present in the neonatal period with congestive cardiac failure. The overall mortality in this series was 20%. Ctu'ldren presenting with intra-cranial arteriovenous malformations require a multidisciplinary approach. The successful management of anaesthesia either for embolization or surgical resection necessitates an understanding of the disciplines of paediatric and neuroanaesthesia. Special care and specific attention to detail may contribute to reduce the high morbidity and mortality encountered in these compromised chiMren. Le traitement neurochirurgical des malformations c~r(brales ar-t~riaveineuses (MAV) repr$sente pour l'anesth$sie un d~fi ma-jeur. Les grosses MAV sont rares chez l'enfant. Seulement 18% deviennent symptomatiques at,ant l'~ge de 15 ans. D'aprbs notre experience de 1982 h 1992, les premieres manifestations sont variables: h~morragie (50%), convulsions et hydroc~phalie (36%) ou d$faillance cardiaque globale (18%). Les sympt&mes de la d~faillance cardiaque globale pr~dominent chez le nouveau-r~ alors que les sympt6mes neurologiques, comme les convulsions et I'hydroc#phalie surviennent plus fr#quemment chez le nourrison et l'enfant plus ~g~. Environ un tiers des MAV de l'enfanee se manifest subitement. Les ~tudes radio-logiques comme la tomodensitom~trie, lfmagerie par r~so-nance magndtique et l'angiogeaphie c~r~brale sont essentielles pour l'identification precise du site de la ldsion. Le traitement peut signifier une cmniotomie pour I'g'vacuation d'un h~ma-tome et le traitement de l~ypertension intracr~nienne. Le contr6le des convulsions et de la d~faillance cardiaque est sou-vent prioritaire et permet de planifier des ...

Gamma Knife surgery for arteriovenous malformations in children

“…The treatment parameters at the initial GKS were as follows: mean prescription dose 21.9 Gy (range 7.5-35 Gy); mean maximum dose 40.1 Gy (range 20-50 Gy); mean isodose line 56% (range 30%-90%); and mean number of isocenters 2.9 (range [1][2][3][4][5][6][7][8][9][10][11][12][13][14]. The treatment parameters of the second GKS were as follows: mean prescription dose 20.7 Gy (range 4-27.5 Gy); mean maximum dose 39.6 Gy (range 8-50 Gy); mean isodose line 53% (range 50%-71%); and mean number of isocenters 4 (range .…”

“…Currently, surgery allows a total extirpation of AVMs in 50%-90% of pediatric patients. 7,8,19 Severe complications after surgery occur in about 10%, with the mortality rate ranging between 0% and 8%. 8,10,16 Therefore, in general, surgery should be considered as a first-line treatment in patients with a superficially located nidus, outside of eloquent cortex.…”

Pediatrik Konjenital Vaskuler Malformasyonlarda Endovaskuler Tedavi

“…AVM'lerin toplumdaki sıklığı %0,5, çocuklar-daki sıklığı ise 0.0014-0.028'dir [22]. Beyinde hayatın herhangi bir döneminde belirti verebilir.…”

“…Ço-cuklarda kanamanın daha yüksek oranlarda gö-rülmesinin nedeni AVM'lerin en sık bazal ganglion ve talamus lokalizasyonunda görülmesi ile açıklanmaktadır [28]. Di Rocco derin yerleşimli AVM'lerin hemisferik olanlara göre kanamaya daha yatkın olduklarını bildirmiştir [22].…”

Angiographic factors associated with haemorrhagic presentation of brain arteriovenous malformation in a Chinese paediatric population

“…[9][10][11] Similar studies on AVM in children are, however, scarce and mostly based on studies from Europe and North America. 12,13 Whether those angiographic features that predict haemorrhage in Caucasian children with AVM similarly predict haemorrhage in Chinese children with AVM is unknown. The objective of this multicentre study was to determine specific angiographic factors associated with haemorrhagic presentation in brain AVM in the Hong Kong Chinese paediatric population, with a view to assisting clinical decision-making regarding the optimal timing and type of treatment.…”