Early Outcomes and Complications of Endovascular Treatment of Cerebral Arteriovenous Malformations in Pediatric Patients

Introduction: Arteriovenous malformations (AVMs) are the commonest cause of hemorrhagic stroke in children. Endovascular embolization is a feasible treatment modality, but cure rates are heterogenous from one series to another. We aimed to describe the immediate obliteration rates and periprocedural complications of embolization of pediatric AVMs. Methods: Between 2011 and 2019, participants below 18 years of age with AVMs treated by the same neurosurgeon at a single center were included. The clinical features, immediate angiographic results, and periprocedural complications were retrospectively collected from the clinical records. Results: Thirty-four embolization sessions were performed on 20 children (12 females with a mean age of 13). Intracranial hemorrhage was the most common presentation (75%), and the majority were frontal (30%) and basal ganglia (30%) lesions. An immediate complete angiographic obliteration was achieved in 9 patients (45%) with low-grade lesions (Spetzler-Martin grade I and II). NBCA was the most common embolic agent used (52.9%). Complications were reported in 3 (8.8%) out of 34 sessions. Two of them were intraoperative perforations with clinical consequences. A slight cortical hemorrhage during the procedure was observed in 1 patient without clinical repercussions. Discussion: This single-surgeon single-center experience suggests that endovascular treatment is a safe and efficient treatment for pediatric AVMs. Pediatric prognostic scores for a suitable selection of candidates are needed. Further studies are required to validate these results.

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Single-center experience with endovascular treatment of cerebral arteriovenous malformations with intent to cure in pediatric patients

Child s Nervous System ◽

10.1007/s00381-021-05376-5 ◽

2021 ◽

Author(s):

Aaron Rodriguez-Calienes ◽

Diego Bustamante-Paytan ◽

Kiara Camacho-Caballero ◽

Angie Mayoria-Vargas ◽

Rodolfo Rodríguez-Varela ◽

...

Keyword(s):

Endovascular Treatment ◽

Arteriovenous Malformations ◽

Pediatric Patients ◽

Single Center ◽

Cerebral Arteriovenous Malformations ◽

Single Center Experience

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Combined (microsurgical and endovascular) treatment of cerebral arteriovenous malformations

Endovascular Neuroradiology ◽

10.26683/2304-9359-2019-3(29)-21-26 ◽

2020 ◽

Vol 29 (3) ◽

pp. 21-26

Author(s):

D.V. Shchehlov ◽

M.S. Gudym ◽

O.E. Svyrydiuk ◽

I.M. Bortnik ◽

M.B. Vyval

Keyword(s):

Endovascular Treatment ◽

Arteriovenous Malformations ◽

Combined Treatment ◽

Postoperative Bleeding ◽

Endovascular Embolization ◽

Neurological Deficits ◽

Subtotal Resection ◽

Low Grade ◽

Treatment Onset ◽

Scientific Practical

Objective – to analyze the results of combined microsurgical and endovascular treatment of brain arteriovenous malformations (AVM).Materials and methods. Radiological and clinical data of 19 patients who underwent preoperative endovascular embolization and resection of the AVM at the SO «Scientific-practical Center of endovascular neuroradiology NAMS of Ukraine» in 2014–2019 were analyzed. Among patients were 11 (57.9 %) women and 8 (42.1 %) men. The average age of patient was 28.4 year (from 15 to 54 years). All AVMs were I–III grade according to the Spetzler–Martin scale.Results. The average AVM size in its maximum dimension was 3.2 cm (range 3.1–6.8 cm). 14 (73.7 %) AVMs were supratentorial and 5 (26.3 %) – subtentorial, in 9 (47.4 %) cases AVMs were located in eloquent areas of the brain, in 1 (5.3 %) – in the motor area. Cerebral or subarachnoid hemorrhage were observed in 12 (63.2 %) cases, seizures – in 4 (21.1 %), headache not associated with bleeding – in 2 (10.5 %) and neurological deficiency not related to the bleeding – in 1 (3.7 %). In 16 (84.2 %) patients total AVM resection was achieved, 3 (15.8 %) patients underwent subtotal resection. Fourteen (73.7 %) patients had good results at discharge (10 (52.6 %) patients had 0 or 1 according to modified Rankin score, and 4 (21.1%) patients had 2), 5 (26.3 %) – 3 and 4. There were no mortality cases after combined endovascular and microsurgical treatment. Onset of new neurological deficits occurred in 5 (26.3 %) patients, and in 3 (15.8 %) cases it regress at discharge and in 2 (10.5 %) cases was permanent.Conclusions. Combined treatment (endovascular embolization and microsurgical resection) of AVMs of the low grade AVM (I–III grade of the Spetzler–Martin scale) allows achieving good treatment results. The use of preoperative endovascular embolization reduces blood flow through the AVM and prevents postoperative hemodynamic overload, intraoperative and/or postoperative bleeding.

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Curative endovascular treatment for low-grade Spetzler-Martin brain arteriovenous malformations: a single-center prospective study

Journal of NeuroInterventional Surgery ◽

10.1136/neurintsurg-2018-014390 ◽

2019 ◽

Vol 11 (7) ◽

pp. 699-705 ◽

Cited By ~ 2

Author(s):

Christina Iosif ◽

Adson Freitas de Lucena ◽

Luiz Gustavo Abreu-Mattos ◽

Victor Hugo Espindola Ala ◽

Amin El-Ghanam ◽

...

Keyword(s):

Endovascular Treatment ◽

Arteriovenous Malformations ◽

Venous Access ◽

Clinical Results ◽

Low Grade ◽

Complication Rates ◽

Single Center ◽

Brain Arteriovenous Malformations ◽

Complete Obliteration ◽

Brain Avms

BackgroundThe treatment of low grade Spetzler-Martin (SM) brain arteriovenous malformations (AVMs) has been debated in unruptured cases. Nevertheless, in clinical practice there are cases where treatment is preferred; in these cases a very low complication rate is mandatory. In ruptured cases, early and complete obliteration of the nidus is the preferred strategy.ObjectiveTo achieve curative embolization, ideally in a single session, by dual microcatheterization techniques with arterial and/or venous access, according to the angioarchitecture.Materials and methodsThis is a prospective, single-center study carried out between January 2008 and January 2016. Patients with ruptured and unruptured brain AVMs, with SM grades I and II, treated by endovascular means, were included. Demographics, clinical presentation, angioarchitecture, and procedure-related complications were analyzed. Angiographic and clinical results were reported.ResultsSeventy-three patients, aged 40.5±17.8 years, were included. More than 60% of the patients presented with ruptured AVMs. Initial SM grades were I for 22% and II for 78% of the patients. Preprocedural modified Rankin Scale (mRS) score was 0–2 for 53 (72.6%), 3 for 12 (16.4%), 4 for 5 (6.8%) and 5 for 3 (4.1%) patients. Procedure-related morbidity was 2.7% and procedure-related mortality was 0%. Ninety percent (90.5%) of the patients were independent in their everyday lives (mRS score 0–2) at 6 months. In all but one case (95%) the embolization was curative.ConclusionStand-alone endovascular treatment for SM grade I and II brain AVMs seems safe and effective, allowing for complete obliteration of the nidus, with low complication rates. A study of larger cohorts is needed.

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Endovascular treatment of cerebellar arteriovenous malformations: A single-center experience of 75 consecutive patients

Neurology India ◽

10.4103/0028-3886.284347 ◽

2020 ◽

Vol 68 (2) ◽

pp. 440

Author(s):

Ming Lv ◽

Yong Sun ◽

Qing Chang ◽

Wei You ◽

Peng Liu ◽

...

Keyword(s):

Endovascular Treatment ◽

Arteriovenous Malformations ◽

Single Center ◽

Single Center Experience

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Pediatric intracranial arteriovenous malformations: a single-center experience

Journal of Neurosurgery Pediatrics ◽

10.3171/2019.9.peds19235 ◽

2020 ◽

Vol 25 (2) ◽

pp. 151-158

Author(s):

Melissa A. LoPresti ◽

Vijay M. Ravindra ◽

Monika Pyarali ◽

Eric Goethe ◽

Nisha Gadgil ◽

...

Keyword(s):

Arteriovenous Malformations ◽

Endovascular Embolization ◽

High Rate ◽

Lower Grade ◽

Single Center ◽

Contributing Factors ◽

Intracranial Arteriovenous Malformations ◽

Patients Âgés ◽

Single Center Experience ◽

Time To Recurrence

OBJECTIVEIntracranial arteriovenous malformations (AVMs) are a common cause of intracranial hemorrhage in children. Exploring outcomes of treatment and factors that predict recurrence may help guide the management of pediatric AVMs. In this study, the authors review a single-center experience with pediatric AVMs, aiming to identify factors contributing to recurrence and areas for improvement in treatment.METHODSA single-center retrospective review of patients ages 0–18 years with AVMs in the period from 2005 to 2018 was conducted. Demographic, clinical, and radiographic data were collected and examined to compare the clinical and functional outcomes of patients managed with and those managed without open microsurgical resection.RESULTSOne hundred five patients were diagnosed and treated during the study period. Fifty (47.6%) had been treated surgically and 35 (33.3%) nonsurgically, and 20 (19%) had been treated primarily at an outside institution and thus were excluded from further analysis. Of the 50 treated surgically, 92% had complete obliteration on postoperative imaging, with the remaining patients having residual AVM and undergoing re-resection or SRS, ultimately resulting in a 96% radiographic cure rate. The surgically treated patients were followed up for an average of 3.34 years. Eighty-two percent had a modified Rankin Scale (mRS) score of 0–2. There was a recurrence rate of 12%, with the time to recurrence averaging 327.86 days (range 85–596 days). Of the 35 patients managed without open surgery, 77% underwent serial imaging surveillance, 20% underwent endovascular embolization, and 3% underwent stereotactic radiosurgery. Radiographic cure was seen in 6% of those treated nonsurgically, and all had undergone endovascular treatment alone. The nonsurgically treated patients were followed up for an average of 2.14 years. Eighty percent had an mRS score of 0–2.CONCLUSIONSThe data revealed that patients with lower-grade AVMs treated surgically and those with higher-grade AVMs managed without surgery have good functional and clinical outcomes. A high rate of recurrence was noted, and the possible contributing factors were explored. The authors encourage further study into mechanisms to reduce AVM recurrence in pediatric patients and look forward to advances in the medical management of lesions that are considered unresectable.

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