Pediatric Dilemma: Endovascular versus Surgical Intervention for Spinal Vascular Malformations

Abstract

Objective: Spinal arteriovenous malformations (AVM) manifest in the pediatric population very differently from the ones in adulthood. Despite that fact, the treatment strategy is quite the same, which provokes a question – whether some of the therapies have an advantage and if so, in which age group. Methods: For this reason, the authors searched the world literature between 1989 and 2018 for spinal AVM in children and further categorized the studies into two age groups: < 12 and ≥12. Results: The total number of included studies in this meta-analysis is 35. Seventeen of them are on the subject of AVM and 15 on the subject of arteriovenous fistula. Three studies encompass both types of lesions. Conclusion: After processing the data, we observed that there is no relationship between age group and the utilized management, except for the endovascular AVF in children less than 12 years of age. Because of this, it should be strongly considered in further management planning.

A Rare Case of Cervical Spinal Arteriovenous Malformation: A Case Report

“…Stereotactic radiosurgery has promising results in AVM treatment, but its role is yet to be established and more research is needed in this area [ 10 , 15 , 16 , 17 , 18 , 19 , 20 , 21 ]. Sherif Rashad et al conducted a single-center observational study, performing radiosurgery with CyberKnife TM in patients who were diagnosed with AVMs and who were not suitable for endovascular treatment or had only experienced partial effects.…”

“…In intramedullary AVMs, complete obliteration is seen in about 33 to 38% and recanalization of AVMs is a common problem requiring repeated embolization and/or surgery. The complete obliteration rate of spinal AVMs after conventional neurosurgery reaches 78%, but the complication rates compared to endovascular treatment are also significantly higher [ 14 , 15 , 16 , 17 , 18 ]. There have been trials to treat AVMs using stereotactic radiosurgery with promising results, indicating that it might be an alternative management strategy for patients who cannot be treated using an endovascular approach or neurosurgery [ 19 , 20 ].…”

“…It is difficult to determine the superior treatment modality, but the current approach is to combine endovascular embolization prior neurosurgery with complete or partial resection for better neurological outcome and obliteration rate [1,3,6,10,11,13,[15][16][17][18][19][20][21].…”

Sirolimus used for treatment of retroperitoneal arteriovenous malformation in a premature neonate

“…Both endovascular and surgical interventions have been utilised for spinal AVMs in children 11. The age of our preterm neonate, the location of the AVM and the size of the feeder vessels ruled out sclerotherapy and embolectomy.…”

A lumbar arteriovenous fistula presenting with intraventricular hemorrhage and hydrocephalus

“…Lesions are most commonly found in the cervical spine or conus medullaris and can present with acute neurological decline that may be related to hemorrhage 2. They can be treated with endovascular and open surgical therapy, and there are no guidelines as to what method is superior 3. Non-traumatic intracranial hemorrhage in children is most often from arteriovenous malformations and less commonly from cavernous malformations or aneurysms.…”