Objectives

We evaluated the safety and efficacy of endovascular embolization as first-line stand-alone strategy for the treatment of low-grade brain arteriovenous malformations (bAVMs) (Spetzler Martin [SM] grade I and II) in pediatric patients. In addition, we assessed the predictors of procedure-related complications and radiographic complete obliteration in a single session.

Material and methods

We conducted a single center retrospective cohort study of all pediatric (≤18 years) patients who underwent embolization as a stand-alone strategy for low-grade bAVMs between 2010 and 2022. Safety was measured by procedure-related complications and mortality. Efficacy was defined as complete angiographic obliteration after the last embolization session.

Results

Sixty-eight patients (41 females; median age 14 years) underwent a total of 102 embolization sessions. There were 24 (35%) SM grade I lesions and 44 (65%) grade II. Six procedure-related complications (5.8% of procedures) were observed and no deaths were reported. All the complications were intraoperative nidus ruptures. A single draining vein was the only significant predictor of procedure-related complications (OR=0.10; 95% CI 0.01 – 0.72; p=0.048). Complete angiographic obliteration was achieved in 44 patients (65%). In 35 patients (51%) the bAVM was completely occluded in one session. The bAVM nidal size was a predictor of complete obliteration in one session (OR=0.44; 95% CI, 0.21–0.80; p=0.017).

Conclusion

Endovascular treatment as a stand-alone strategy for pediatric low-grade bAVMs is an adequate first-line approach in high volume centers with endovascular expertise. Nidal size evaluation is relevant in order to optimize patient selection for embolization as a stand-alone treatment modality.

中文翻译：

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栓塞作为儿童低级别脑动静脉畸形的独立策略

目标

我们评估了血管内栓塞作为治疗儿科患者低级别脑动静脉畸形 (bAVM)（Spetzler Martin [SM] I 级和 II 级）的一线独立策略的安全性和有效性。此外，我们还评估了单次手术相关并发症和影像学完全闭塞的预测因素。

材料与方法

我们对 2010 年至 2022 年间接受栓塞治疗作为低级别 bAVM 独立策略的所有儿科（≤18 岁）患者进行了一项单中心回顾性队列研究。安全性通过手术相关并发症和死亡率来衡量。疗效定义为最后一次栓塞治疗后血管造影完全闭塞。

结果

68 名患者（41 名女性；中位年龄 14 岁）共接受了 102 次栓塞治疗。有 24 个 (35%) SM I 级病变和 44 个 (65%) II 级病变。观察到六种手术相关并发症（占手术的 5.8%），没有死亡报告。所有并发症均为术中病灶破裂。单个引流静脉是手术相关并发症的唯一重要预测因素（OR=0.10；95% CI 0.01 – 0.72；p =0.048）。44 名患者 (65%) 实现了血管造影完全闭塞。在 35 名患者 (51%) 中，bAVM 在一次治疗中完全闭塞。bAVM 巢腔大小是一个疗程中完全闭塞的预测指标（OR=0.44；95% CI，0.21–0.80；p =0.017）。

结论

血管内治疗作为儿科低级别 bAVMs 的独立策略是具有血管内专业知识的大容量中心的适当一线方法。Nidal 大小评估是相关的，以便优化患者选择栓塞作为一种独立的治疗方式。