title: Surgical management of arteriovenous malformations in children.
abstract: OBJECTIVE
  Children compose 3 to 20% of the patients with arteriovenous malformations (AVMs); however, AVMs are responsible for 30 to 50% of intracranial hemorrhages in children.
  
  
  METHODS
  The medical records of 82 children with 84 AVMs treated surgically between 1983 and 2005 were reviewed. Fifty-two patients (63%) presented with hemorrhage, 13.4% presented with seizures, and AVMs in 12% were found incidentally. Patients with brainstem lesions presented at a significantly younger age (p = 0.002) than those harboring lesions in other locations. Frontal lobe lesions were significantly smaller than those in other locations, and thalamic lesions were significantly larger (p = 0.012 and 0.005, respectively). Most patients with Spetzler-Martin Grades I to III lesions underwent craniotomy only. Half of the patients with Grade IV and V lesions underwent embolization, craniotomy, and radiosurgery. The mean follow-up period was 43 months. Postoperatively, the initial obliteration rate was 65%, with a long-term obliteration rate of 90%. The perioperative mortality rate was 3.7%. Altogether, 81% of patients had excellent outcomes, and patients with Grade I lesions had the best outcomes. Of the 52 patients who presented with hemorrhage, 17% had fair or poor outcomes. The recurrence rate was 5.6%.
  
  
  CONCLUSIONS
  Children with AVMs may be more prone than adults to present with a hemorrhage and to experience recurrence of the lesion after treatment. The authors favor resection for most AVMs in children and use embolization as a preoperative strategy for Grades II to V lesions treated surgically. Prehemorrhagic Grade IV and V lesions may best be treated conservatively and observed carefully for the development of symptoms. Long-term follow up of all patients is essential.
authors.affiliation: Division of Neurological Surgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona 85013, USA.
authors.forename: Ruth E
authors.initials: RE
authors.lastname: Bristol
authors.forename: Felipe C
authors.initials: FC
authors.lastname: Albuquerque
authors.forename: Robert F
authors.initials: RF
authors.lastname: Spetzler
authors.forename: Harold L
authors.initials: HL
authors.lastname: Rekate
authors.forename: Cameron G
authors.initials: CG
authors.lastname: McDougall
authors.forename: Joseph M
authors.initials: JM
authors.lastname: Zabramski
mesh_terms: D002543:Cerebral Hemorrhage / Q000401:mortality / Q000601:surgery* / Q000628:therapy*; D002648:Child; D003399:Craniotomy; D004621:Embolization, Therapeutic; D005500:Follow-Up Studies; D006801:Humans; D002538:Intracranial Arteriovenous Malformations / Q000401:mortality / Q000601:surgery* / Q000628:therapy*; D011183:Postoperative Complications; D016634:Radiosurgery; D012008:Recurrence; D020521:Stroke / Q000401:mortality / Q000601:surgery / Q000628:therapy; D016896:Treatment Outcome