title: [Urgent removal of ruptured cerebral arteriovenous malformations in children].
abstract: In 60-80% of children with arteriovenous malformation (AVM), the first manifestation is an abrupt rupture resulting in intracranial hemorrhage. Some cases of acute rupture result in compressive hematoma, severe mass effect and comatose patients. Acute surgery on cerebral arteriovenous malformations (AVMs) has seldom been reported or used. The authors present case reports of 3 children (ages: five months, 7 and 9 years) who underwent craniotomy for intraparenchymal hematoma evacuation and AVM removal within a few hours of bleeding. All 3 children arrived with decreased Levels of consciousness and rapid neurological deterioration. The 5 months old boy also suffered hypovolemic shock. The fast neurological worsening and mass effect of the extensive intracerebral hemorrhage prompted early surgical treatment. Due to active bleeding from the AVM, it was already resected in the acute stage using minimal invasive techniques. After one year of follow-up, all 3 children fully recovered with no neurological deficit. Post-operative angiography was performed to confirm that the malformation was totally removed. The management of AVM should include formal angiography, with or without endovascular embolization and late surgery when indicated. In this report, the authors presented 3 children who underwent urgent resection of the lesion with full neurological recovery. The management of AVM is reviewed with comparisons between surgical resection in the acute phase versus the late phase.
authors.affiliation: Pediatric Neurosurgical Unit, Neurosurgery Department, Soroka Medical Center and Faculty of Health Sciences Ben Gurion University Beer Sheba, Israel. moni@bgu.ac.il
authors.forename: Mony
authors.initials: M
authors.lastname: Benifla
authors.forename: Ilan
authors.initials: I
authors.lastname: Shelef
authors.forename: Israel
authors.initials: I
authors.lastname: Melamed
authors.forename: Vladimir
authors.initials: V
authors.lastname: Merkin
authors.forename: Revital
authors.initials: R
authors.lastname: Barrelly
authors.forename: Avi
authors.initials: A
authors.lastname: Cohen
mesh_terms: D002543:Cerebral Hemorrhage / Q000000981:diagnostic imaging* / Q000601:surgery*; D002648:Child; D003399:Craniotomy / Q000379:methods; D005500:Follow-Up Studies; D006801:Humans; D007223:Infant; D002538:Intracranial Arteriovenous Malformations / Q000000981:diagnostic imaging / Q000601:surgery*; D008297:Male; D019060:Minimally Invasive Surgical Procedures / Q000379:methods; D011859:Radiography; D016634:Radiosurgery / Q000009:adverse effects / Q000379:methods; D016896:Treatment Outcome