Document Detail


Pediatric arteriovenous malformations: a 15-year experience with an emphasis on residual and recurrent lesions.
MedLine Citation:
PMID:  17053936     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
OBJECT: Pediatric arteriovenous malformations (AVMs) are generally treated with microsurgical resection to achieve complete obliteration. We review our experience treating AVMs in children, particularly those with residual or recurrent lesions. METHODS: The records of 39 patients with AVMs (25 girls: 14 boys; average age 10.3 years) treated during a 15-year period were reviewed (mean follow-up 30 months). Three primary outcomes were analyzed: AVM obliteration by last follow-up, residual on postoperative angiograms and recurrence after angiographic "cure." RESULTS: Most children (57%) presented with spontaneous intracerebral hemorrhage, the average nidus size was 3.4 cm, and the modal Spetzler-Martin grade was 2. AVMs were classified as compact (82%) or diffuse (18%). Most patients (90%) underwent surgery as their primary treatment. The immediate obliteration rate was 76% and the overall, long-term obliteration rate was 89%. Nine (23%) patients had residual nidus after initial treatment; five of these underwent further treatment that obliterated their lesion. Five (13%) patients developed recurrence within 6 years, including one patient with two recurrences. Three were successfully treated with a repeat resection. Patients with diffuse-type AVMs were at greater risk of having a persistent lesion (40%), residual lesion (44%), or recurrence (80%) at last follow-up. CONCLUSION: Most pediatric AVMs can be successfully treated with microsurgical resection. Endovascular treatment is reserved primarily as a preoperative adjunct and stereotactic radiosurgery for inoperable AVMs. Patients may develop recurrences years after their original treatment. Patients with diffuse-type AVMs were less likely to be cured and more likely to have a residual or a recurrence.
Authors:
Paul Klimo; Ganesh Rao; Douglas Brockmeyer
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Publication Detail:
Type:  Case Reports; Journal Article     Date:  2006-10-13
Journal Detail:
Title:  Child's nervous system : ChNS : official journal of the International Society for Pediatric Neurosurgery     Volume:  23     ISSN:  0256-7040     ISO Abbreviation:  Childs Nerv Syst     Publication Date:  2007 Jan 
Date Detail:
Created Date:  2006-12-04     Completed Date:  2007-11-13     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  8503227     Medline TA:  Childs Nerv Syst     Country:  Germany    
Other Details:
Languages:  eng     Pagination:  31-7     Citation Subset:  IM    
Affiliation:
Department of Neurosurgery, University of Utah, Primary Children's Medical Center, 100 N. Medical Drive, Salt Lake City, UT 84113, USA.
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MeSH Terms
Descriptor/Qualifier:
Adolescent
Arteriovenous Malformations / pathology*,  physiopathology*,  surgery*
Child
Child, Preschool
Female
Humans
Infant
Male
Microsurgery
Neurosurgical Procedures
Radiosurgery
Recurrence
Treatment Outcome
Vascular Surgical Procedures

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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