Purpose

Compared to adult AVMs, there is a paucity of data on the microsurgical treatment of pediatric AVMs. We report our institutional experience with pediatric AVMs treated by microsurgical resection with or without endovascular embolization and radiation therapy.

Methods

We retrospectively reviewed all patients ≤ 18 years of age with cerebral AVMs that underwent microsurgical resection at Rady Children’s Hospital 2002–2019.

Results

Eighty-nine patients met inclusion criteria. The mean age was 10.3 ± 5.0 years, and 56% of patients were male. In total, 72 (81%) patients presented with rupture. Patients with unruptured AVMs presented with headache (n = 5, 29.4%), seizure (n = 9, 52.9%), or incidental finding (n = 3, 17.7%). The mean presenting mRS was 2.8 ± 1.8. AVM location was lobar in 78%, cerebellar/brainstem in 15%, and deep supratentorial in 8%. Spetzler-Martin grade was I in 28%, II in 45%, III in 20%, IV in 6%, and V in 1%. Preoperative embolization was utilized in 38% of patients and more frequently in unruptured than ruptured AVMs (62% vs. 32%, p = 0.022). Radiographic obliteration was achieved in 76/89 (85.4%) patients. Complications occurred in 7 (8%) patients. Annualized rates of delayed rebleeding and recurrence were 1.2% and 0.9%, respectively. The mean follow-up was 2.8 ± 3.1 years. A good neurological outcome (mRS score ≤ 2) was obtained in 80.9% of patients at last follow-up and was improved relative to presentation for 75% of patients.

Conclusions

Our case series demonstrates high rates of radiographic obliteration and relatively low incidence of neurologic complications of treatment or AVM recurrence.

中文翻译：

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儿童动静脉畸形手术：拉迪儿童医院的经验（2002–2019）

目的

与成人AVM相比，小儿AVM的显微外科治疗数据很少。我们报告我们的机构经验与通过或不进行血管内栓塞和放疗的显微外科切除术治疗的小儿AVM。

方法

我们回顾性研究了2002-2019年在Rady儿童医院接受脑外科手术的所有18岁以下脑AVM的患者。

结果

89名患者符合入选标准。平均年龄为10.3±5.0岁，其中56％为男性。共有72例（81％）患者出现破裂。AVM破裂的患者出现头痛（n  = 5，29.4％），癫痫发作（n  = 9，52.9％）或偶然发现（n  = 3，17.7％）。平均呈现mRS为2.8±1.8。AVM的位置是大叶，占78％，小脑/脑干占15％，深部幕上占8％。Spetzler-Martin成绩为I（28％），II（45％），III（20％），IV（6％）和V（1％）。术前栓塞在38％的患者中得到了应用，未破裂的患者比破裂的AVM更为频繁（62％vs. 32％，p = 0.022）。76/89（85.4％）患者完成了放射学消除。7（8％）例患者发生并发症。延迟再出血的年率和复发率分别为1.2％和0.9％。平均随访时间为2.8±3.1年。在最后一次随访中，有80.9％的患者获得了良好的神经学预后（mRS评分≤2），相对于75％的患者表现而言有所改善。

结论

我们的病例系列显示出较高的放射学闭塞率和相对较低的治疗或AVM复发神经系统并发症发生率。