Introduction: Brain arteriovenous malformations (AVMs) are a common cause of intracranial hemorrhage in children. The 2-4% annual risk of AVM hemorrhage creates a greater lifetime risk compared to adults. Few series describe the management and outcomes of pediatric AVMs.
Methods: 47 (18%) consecutive pediatric patients were identified from a retrospective review of 264 AVMs treated from 2005-2012. The World Federation of Neurosurgical Societies (WFNS) score was used for status at presentation. The modified Rankin scale (mRS) was used to assess functional outcome at last follow-up.
Results: Baseline patient characteristics and treatment modalities are detailed in Tables 1 & 2. 96% patients completed treatment with a mean follow-up of 1.7 years. 68% presented with hemorrhage, and 32% presented unruptured. 56% of ruptured patients underwent surgery -/+ preoperative embolization compared to 40% of unruptured patients. The mean Spetzler-Martin grade in surgical patients was 2.3 compared to 3.2 in radiosurgical patients (p = .009). Radiosurgery was performed after surgery for cases of recurrence (1/27 patients, 4%) and residual (2/27 patients, 7%) – all in Grade 4 AVMs. The overall surgical cure rate was 89% and 100% for grades 1-3 (21 patients). In radiosurgical patients with more than 2 years follow-up, 11/13 (85%) patients obtained a radiographic cure and 100% for Grades 1-3 (7 patients). 78% surgical patients and 75% radiosurgical patients were mRS 0-2 at last follow-up. For ruptured patients, 88% were mRS 0-2 compared to 69%, if presenting with WFNS 1-3 and 4-5, respectively. For unruptured patients, 73% were mRS 0-2 (88% of Grades 1-3; 57% of Grades 4-5).
Conclusions: Surgical resection and stereotactic radiosurgery may offer similar clinical and radiographic outcomes in pediatric patients. For unruptured pediatric AVMs, treatment likely has greater risk with high grade AVMs, and prospective, multicenter data may help stratify the risk and benefits of treatment in that subset of patients.
Patient Care: Few publications on AVM management focus directly on the clinical and radiographic outcomes for pediatric patients. This study adds to the growing body of literature and has found that surgical and radiosurgical outcomes may be similar.
Learning Objectives: 1) By the conclusion of this session, participants should be able to describe outcomes after multimodality treatment of pediatric AVMs.
2) Discuss the indications of surgical and radiosurgical therapy for pediatric AVMs.
3) Identify an effective treatment for pediatric AVMs.