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Arteriovenous Malformations of the Brain in Children: A Forty Year Experience

Published online by Cambridge University Press:  18 September 2015

Douglas Kondziolka*
Affiliation:
Division of Neurosurgery, Hospital for Sick Children, University of Toronto, Toronto
Robin P. Humphreys*
Affiliation:
Division of Neurosurgery, Hospital for Sick Children, University of Toronto, Toronto
Harold J. Hoffman*
Affiliation:
Division of Neurosurgery, Hospital for Sick Children, University of Toronto, Toronto
E. Bruce Hendrick*
Affiliation:
Division of Neurosurgery, Hospital for Sick Children, University of Toronto, Toronto
James M. Drake*
Affiliation:
Division of Neurosurgery, Hospital for Sick Children, University of Toronto, Toronto
*
Division of Neurosurgery, Hospital for Sick Children, 555 University Avenue, Toronto, Ontario, Canada M5G 1X8
Division of Neurosurgery, Hospital for Sick Children, 555 University Avenue, Toronto, Ontario, Canada M5G 1X8
Division of Neurosurgery, Hospital for Sick Children, 555 University Avenue, Toronto, Ontario, Canada M5G 1X8
Division of Neurosurgery, Hospital for Sick Children, 555 University Avenue, Toronto, Ontario, Canada M5G 1X8
Division of Neurosurgery, Hospital for Sick Children, 555 University Avenue, Toronto, Ontario, Canada M5G 1X8
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Abstract:

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Despite the great capacity for the pediatric brain to recover from stroke, the morbidity and mortality in children who harbor an arteriovenous malformation (AVM) remains high. This study examines the clinical data and management experience with 132 patients with brain AVM from 1949 to 1989. Although the high tendency for a childhood AVM to present with hemorrhage (79%) remained constant for the forty year study period, the associated morbidity and mortality of hemorrhage changed. The mortality rate from hemorrhage for the entire series was 25%, which was reduced from 39% to 16% after the introduction of computed tomography. The mortality from AVM hemorrhage since 1975 was dependent on location; 8 of 14 patients (57%) with a cerebellar AVM died from hemorrhage while only 2 of 44 patients (4.5%) with a cerebral hemisphere AVM died (p < 0.0001). Sixteen children (12%) presented with a chronic seizure disorder. Surgical excision of the malformation resulted in complete seizure control off anti-convulsant medication in 73% of patients. Although 21% of patients were treated non-operatively (many with terminal poor-grade hemorrhage), 79% had a surgical procedure with total AVM excision achieved in 70 patients (53.1%). Complete AVM resection was followed by a normal neurological outcome in 47 children (67%). Most partial excisions (n=9) and clipping of feeding arteries (n=7) were performed in the early years of this study, and did not provide protection from rehe-morrhage. Although conservative management has been advocated for selected non-hemorrhagic AVMs, we conclude that essentially all children with an AVM should be treated in order to eliminate the risk of hemorrhage. Long-term conservative management in pediatric patients is warranted only in patients with large AVMs not amenable to treatment using current multimodality techniques.

Type
Articles
Copyright
Copyright © Canadian Neurological Sciences Federation 1992

References

1. Mori, K, Murata, T, Hashimoto, N, et al. Clinical analysis of arteriovenous malformations in children. Childs Brain 1980; 6: 1325.Google Scholar
2. McCormick, WE.Pathology of vascular malformations of the brain. In: Wilson, C, Stein, B, eds. Intracranial Arteriovenous Malformations. Baltimore: Williams and Wilkins, 1984: 4463.Google Scholar
3. Padget, DH.The cranial venous system in man in reference to development, adult configuration and relation to the arteries. Am J Anat 1956; 98:307355.Google Scholar
4. Takashima, S, Becker, LE.Neuropathology of cerebral arteriovenous malformations in children. J Neurol Neurosurg Psychiatry 1980; 43: 380385.Google Scholar
5. Graf, CJ, Perret, GE, Tomer, JC.Bleeding from cerebral arteriovenous malformations as part of their natural history. J Neurosurg 1983; 58:331337.Google Scholar
6. Guidetti, B, Delitala, A.Intracranial arteriovenous malformations. Conservative and surgical treatment. J Neurosurg 1980; 53: 149152.Google Scholar
7. Heros, RC, Korosue, K, Diebold, PM.Surgical excision of cerebral arteriovenous malformation: late results. Neurosurgery 1990; 26: 578579.Google Scholar
8. Itoyama, Y, Uemura, S, Ushio, Y, et al. Natural course of unoperated intracranial arteriovenous malformations: study of 50 cases. J Neurosurg 1989; 71: 805809.Google Scholar
9. Jomin, M, Lesoin, F, Lozes, G.Prognosis for arteriovenous malformations of the brain in adults based on 150 cases. Surg Neurol 1985; 23: 362366.Google Scholar
10. Perret, G, Nishioka, H.Arteriovenous malformations: An analysis of 545 cases of cranio-cerebral arteriovenous malformations and fistulae reported to the Co-operative Study. J Neurosurg 1966; 25: 467490.Google Scholar
11. Humphreys, RP.Hemorrhagic stroke in childhood. J Pediatr Neurosci 1986; 2: 110.Google Scholar
12. Botterell, EH, Lougheed, WM, Scott, JW, et al. Hypothermia, and interruption of carotid, or carotid and vertebral circulation, in the surgical management of intracranial aneurysms. J Neurosurg 1956; 13: 142.Google Scholar
13. Spetzler, RF, Wilson, CB, Weinstein, P, et al. Normal perfusion pressure breakthrough theory. Clin Neurosurg 1977; 25: 651672.Google Scholar
14. Matson, DD.Neurosurgery of Infancy and Childhood. Springfield: Thomas, 1969: 749766.Google Scholar
15. Celli, P, Ferrante, L, Palma, L, et al. Cerebral arteriovenous malformations in children. Clinical features and outcome of treatment in children and in adults. Surg Neurol 1984; 22: 4349.Google Scholar
16. Gerosa, MA, Cappellotto, P, Licata, C, et al. Cerebral arteriovenous malformations in children (56 cases). Childs Brain 1981; 8: 356371.Google Scholar
17. Fults, D, Kelly, DL.Natural history of arteriovenous malformations of the brain: A clinical study. Neurosurgery 1984; 15: 658662.Google Scholar
18. Crawford, PM, West, CR, Chadwick, DW, et al. Arteriovenous malformations of the brain: natural history in unoperated patients. J Neurol Neurosurg Psychiatry 1986; 49: 110.Google Scholar
19. Ondra, SL, Troupp, H, George, ED, et al. The natural history of symptomatic arteriovenous malformations of the brain: a 24-year follow-up assessment. J Neurosurg 1990; 73: 387391.Google Scholar
20. Wilkins, RH.Natural history of intracranial vascular malformations: A review. Neurosurgery 1985; 16:421430.Google Scholar
21. Leblanc, R, Feindel, W, Ethier, R.Epilepsy form cerebral arteriovenous malformations. Can J Neurol Sci 1983; 10: 9195.Google Scholar
22. Yeh, HS, Kashiwagi, S, Tew, JM, et al. Surgical management of epilepsy associated with cerebral arteriovenous malformations. J Neurosurg 1990; 72: 216223.Google Scholar
23. Humphreys, RP, Hendrick, EB, Hoffman, HJ.Arteriovenous malformations of the brainstem in childhood. Childs Brain 1984; 11: 111.Google Scholar
24. Logue, V, Monckton, G.Posterior fossa angiomas. A clinical presentation of nine cases. Brain 1954; 77: 252273.Google Scholar
25. Drake, CG.Cerebral arteriovenous malformations: considerations for and experience with surgical treatment in 166 cases. Clin Neurosurg 1979; 26: 145208.Google Scholar
26. Russo, RH, Dicks, RE.Arteriovenous malformations of the brain stem in childhood. Surg Neurol 1977; 8: 167170.Google Scholar
27. Sundaresan, N, Galicich, J, Krol, G, et al. Successful surgical treatment of pontine vascular malformation in a 3-year old. Childs Brain 1979; 5: 131136.Google Scholar
28. Solomon, RA, Stein, BM.Management of arteriovenous malformations of the brain stem. J Neurosurg 1986; 64: 857864.Google Scholar
29. Altschuler, EM, Lunsford, LD, Coffey, RJ, et al. Gamma Knife radiosurgery for intracranial arteriovenous malformations in childhood and adolescence. Pediatr Neurosci 1989; 15: 5361.Google Scholar
30. Lunsford, LD, Kondziolka, D, Flickinger, JC, et al. Stereotactic radiosurgery for arteriovenous malformations of the brain. J Neurosurg (in press).Google Scholar
31. Cohen, HCM, Tucker, WS, Humphreys, RP, et al. Angiographically occult histologically verified cerebrovascular malformations. Neurosurgery 1982; 10: 704714.Google Scholar
32. Garza-Mercado, R, Caravos, E, Tamez-Montes, D.Cerebral arteriovenous malformations in children and adolescents. Surg Neurol 1987; 27: 131140.Google Scholar
33. Humphreys, RP, Hendrick, EB, Hoffman, HJ.Arteriovenous malformations of the brain. Concepts Pediatr Neurosurg 1988; 8: 146164.Google Scholar
34. Forster, DMC, Steiner, L, Hakanson, S.Arteriovenous malformations of the brain. A long-term clinical study. J Neurosurg 1972; 37: 562570.Google Scholar
35. So, SC.Cerebral arteriovenous malformations in children. Childs Brain 1977; 4:242250.Google Scholar
36. Kelly, JJ, Mellinger, JF, Sundt, TM.Intracranial arteriovenous malformations in childhood. Ann Neurol 1978; 3: 338343.Google Scholar
37. Martin, NA, Edwards, MSB.Supratentorial arteriovenous malformations. In: Edwards, M, Hoffman, H, eds. Cerebral Vascular Disease in Children and Adolescents. Baltimore: Williams and Wilkins, 1989: 283308.Google Scholar
38. Amacher, AL, Drake, CG, Hovind, L.The results of operating upon aneurysms and angiomas in children and adolescents. Part II: cerebral angiomas. Childs Brain 1979; 5: 166173.Google Scholar
39. Spetzler, RF, Martin, NA, Carter, LP, et al. Surgical management of large AVMs by staged embolization and operative excision. J Neurosurg 1987; 67: 1728.Google Scholar
40. Godersky, JC, Menezes, AH.Intracranial arteriovenous anomalies in infancy: modern concepts. Pediatr Neurosci 1987; 13: 242250.Google Scholar