Clinical features and endovascular treatment of intracranial arteriovenous malformations in pediatric patients

Abstract

AVM size and deep venous drainage were independently associated with hemorrhage in pediatric patients. Endovascular procedure is feasible and safe for pediatric AVMs, and complete embolization can be achieved in small AVMs, while large AVMs can be adequately reduced in size for additional microsurgery or stereotactic radiosurgery.

Postoperative imaging for detection of recurrent arteriovenous malformations in children

“…2,8,19 Only 18%-20% of patients with AVMs present before 15 years of age, 13,17 with hemorrhage and seizure being the most common primary events. 1,5,31,32 Treatment of AVMs includes microsurgical resection, radiosurgery, endovascular embolization, or a combination of these strategies. 3,6,24,28 Accumulating evidence has demonstrated that AVMs recur in children.…”

Periventricular Location as a Risk Factor for Hemorrhage and Severe Clinical Presentation in Pediatric Patients with Untreated Brain Arteriovenous Malformations

“…24,26,28 Two larger studies reported results with a relatively distinct bias (a wide range of odds ratio or only radiosurgery patients), suggesting that these studies might have been underpowered to assess the impact of certain features on BAVM hemorrhage. 25,27 In this exclusively pediatric cohort (18 years old or younger) of patients with BAVMs referred to a high-volume Chinese neurosurgery center during the past 5 years, we identified periventricular nidus location and smaller nidus size as independent predictors of hemorrhagic presentation. In contrast to adult patients, deep location, exclusively deep venous drainage, and associated aneurysms were not significantly correlated with the appearance of hemorrhage in these children.…”

“…[24][25][26][27][28] Most of these factors and results were obtained from a retrospective cohort (younger than 22 years of age) at Columbia University Medical Center. 24,26,28 Two larger studies reported results with a relatively distinct bias (a wide range of odds ratio or only radiosurgery patients), suggesting that these studies might have been underpowered to assess the impact of certain features on BAVM hemorrhage.…”

“…Previous studies have identified some morphologic factors that are significant at presentation but do not necessarily predict future hemorrhages in pediatric patients with BAVMs. [24][25][26][27][28] While the long-term follow-up of prospective studies such as A Randomized Trial of Unruptured Brain Arteriovenous Malformations will clarify features that predict future hemorrhage in adults with BAVMs, these studies are less likely to be performed in pediatric patients, a group in which most patients present with hemorrhage; ethical dilemmas could arise during conservative treatment with observation of known BAVMs. 30 Assuming that the BAVM had been present since birth, thereby accumulating a large number of patient-years of follow-up, we found an overall annual hemorrhage rate of 5.47% in children with BAVMs, which is much higher than the 2.0% reported in a previous study.…”

Arteriovenous Malformations in the Pediatric Population: Review of the Existing Literature

“…Although AVMs are less common in kids [5], they are still considered the most frequent abnormality of intracranial circulation in childhood [16], and they are the most common cause of spontaneous intraparenchymal hemorrhage in children. Pediatric AVMs could also present with recurrent seizures or headaches [17,18,19,20,21]. The natural history of AVMs in children is not well studied or understood; in part, this might be due to the initial emergent therapy of these lesions.…”