Curative embolization of ruptured pediatric cerebral arteriovenous malformations

Pediatric Cerebral Vascular Malformations : Current and Future Perspectives

“…One of the most important advances in the surgical treatment of pediatric cerebrovascular lesions has not been technical, but rather has consisted of clarification of operative indications based on data-driven guidelines. For AVMs, the controversial ARUBA (A Randomised trial of Unruptured Brain Arteriovenous malformations) trial had previously discouraged treatment of asymptomatic lesions, but recent analysis of the pediatric patients in this study actually strongly supports operative intervention – markedly reversing the initial consensus [ 20 , 22 , 34 , 48 ]. Additional studies, citing the expected long lifespan of children, the plasticity of pediatric neural pathways in recovering from treatment side effects and the improvement in surgical outcomes, have increasingly supported surgical treatment of pediatric AVMs in an expanding number of clinical scenarios, including many asymptomatic lesions (of note, radiosurgery, including Gamma Knife, remains an additional, well-documented treatment option for many AVMs) [ 10 , 20 , 22 , 48 ].…”

“…Stand-alone embolization as definitive treatment of highflow vascular lesions has increasingly been reported. While this approach is often successful for VOGM (typically requiring multiple rounds of embolization), or single-hole fistulae, it is more controversial with nidal AVMs [ 4 , 41 , 47 , 48 ]. Initial data suggests that attempts to cure complex nidal AVMs with embolization alone may actually worsen the bleeding risk and outcomes relative to natural history – and, as such, it is increasingly discouraged in many high-volume centers [ 20 , 22 , 48 ].…”

Worldwide Research Trends on Transvenous Embolization of Brain Arteriovenous Malformations: A Bibliometric and Visualized Study

“…6,9,10 However, curative embolization is a feasible option but entails higher complication rates compared with the modalities mentioned earlier. [11][12][13][14][15] An attractive endovascular approach is transvenous embolization (TVE), which has reached high occlusion rates (>90%) immediately and at follow-up, low complication rates, and good clinical outcomes evaluated with the modified Rankin Scale. 16 This technique is used in selected cases, such as small nidus (<3 cm), deep-seated lesions, the absence of potential feeders, the presence of a single draining vein, and previously treated lesions with inaccessible arterial feeders.…”