Document Detail


Management of Pediatric Intracranial Arteriovenous Malformations: Experience with Multimodality Therapy.
MedLine Citation:
PMID:  21430584     Owner:  NLM     Status:  Publisher    
Abstract/OtherAbstract:
BACKGROUND:: Successful management of pediatric arteriovenous malformations (AVMs) often requires a balanced application of embolization, surgery, and radiosurgery. OBJECTIVE:: The authors describe their experience treating pediatric AVMs. METHODS:: We analyzed 120 pediatric (<18 years) AVMs treated with various combinations of radiosurgery, surgery, and endovascular techniques. RESULTS:: Between 1985-2009, 76 children with low Spetzler-Martin grade (I-III) and 44 with high-grade (IV-V) AVMs were treated. Annual risk of hemorrhage from presentation to initial treatment was 4.0%, decreasing to 3.2% after treatment initiation until confirmed obliteration. AVM obliteration results were available in 101 patients. Initial single-modality therapy led to AVM obliteration in 51/67 (76%) low-grade and 3/34 (9%) high-grade AVMs, improving to 58/67 (87%) and 9/34 (26%) respectively with further treatment. Mean time to obliteration was 1.8 years for low-grade and 6.4 years for high-grade AVMs. Disabling neurological complications occurred in 4/77 (5%) low-grade and 12/43 (28%) high-grade AVMs. At final clinical follow-up (mean 9.2 yrs), 48/67 (72%) with low-grade lesions had mRS 0-1, compared to 12/34 (35%) for high-grade AVMs. On multivariate analysis, significant risk factors for poor final clinical outcome (mRS ≥2) included baseline mRS ≥2 (OR 9.51 [95% CI: 3.31, 27.37] P<0.01), left-sided location (OR 3.03 [95% CI: 1.11, 8.33] P=0.03), and high AVM grade (OR 4.35 [95% CI: 1.28, 14.28] P=0.02). CONCLUSION:: Treatment of pediatric AVMs with multimodality therapy can substantially improve obliteration rates and may decrease AVM hemorrhage rates. The poor natural history and risks of intervention must be carefully considered when deciding to treat high-grade pediatric AVMs.
Authors:
Tim E Darsaut; Raphael Guzman; Mary L Marcellus; Michael S Edwards; Lu Tian; Huy M Do; Steven D Chang; Richard P Levy; John R Adler; Michael P Marks; Gary K Steinberg
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Publication Detail:
Type:  JOURNAL ARTICLE     Date:  2011-3-23
Journal Detail:
Title:  Neurosurgery     Volume:  -     ISSN:  1524-4040     ISO Abbreviation:  -     Publication Date:  2011 Mar 
Date Detail:
Created Date:  2011-3-24     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  7802914     Medline TA:  Neurosurgery     Country:  -    
Other Details:
Languages:  ENG     Pagination:  -     Citation Subset:  -    
Affiliation:
1Department of Neurosurgery, Stanford University School of Medicine, Stanford, CA; 2Department of Radiology, Stanford University School of Medicine, Stanford, CA; 3Department of Health Research and Policy, Stanford University School of Medicine, Stanford, CA; 4Department of Radiation Oncology, Loma Linda Medical Center, Loma Linda, CA.
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