Multimodality treatment of cerebral AVMs in children: a single-centre 20 years experience.
OBJECTIVE
The purpose of this study was to review our experience with a multimodality treatment approach in the management of cerebral arteriovenous malformation (AVM) in children.


METHODS
We retrospectively analysed a consecutive series of 56 children who harboured a cerebral AVM and were treated at our institution between 1988 and 2008. During the whole treatment period, a combined treatment strategy, including microsurgery, endovascular treatment and gamma knife radiosurgery, was used.


RESULTS
Of the 56 patients (median age, 14.0; range, 3 months-18 years) reported, 36 (64.3%) were admitted after AVM rupture; of these, only one AVM (1.8%) was considered untreatable. In 30.9% (17/55) of the treated patients, a single treatment measure was sufficient to attain angiographic cure of the AVM. Among these, six patients (10.9%) had microsurgical AVM resection, four patients (7.3%) underwent endovascular treatment, and another seven patients (12.7%) underwent radiosurgical management of the AVM. The majority of the population (38/55; 69.1%) underwent combined treatment: 21 patients (38.2%) received embolisation followed by radiosurgery of the remnant nidus, ten patients (18.2%) underwent embolisation with subsequent surgical resection of the residual AVM, three patients (5.5%) had radiosurgery after incomplete surgical AVM nidus resection and another four patients (7.3%) required a combination of all three treatment modalities to achieve permanent angiographic cure of the AVM. We observed good clinical outcomes (Glasgow Outcome Scale 5 and 4) in 94.6% of the children. Complete angiographic obliteration was achieved in 93.3% of the patients treated.


CONCLUSIONS
A multimodality treatment approach in children harbouring cerebral AVMs leads to excellent angiographic and clinical outcomes.
Dorfer
Christian
C
Department of Neurosurgery, Medical University Vienna, Waehringer Guertel 18-20, 1090 Vienna, Austria. christian.dorfer@meduniwien.ac.at
Czech
Thomas
T
Bavinzski
Gerhard
G
Kitz
Klaus
K
Mert
Aygül
A
Knosp
Engelbert
E
Gruber
Andreas
A
D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D003131:Combined Modality Therapy; D004621:Embolization, Therapeutic; D005260:Female; D006801:Humans; D007223:Infant; D002538:Intracranial Arteriovenous Malformations / Q000628:therapy*; D008297:Male; D019635:Neurosurgical Procedures; D016634:Radiosurgery; D012189:Retrospective Studies