title: Clinical, radiological profile and outcome in pediatric Spetzler-Martin grades I-III arteriovenous malformations.
abstract: BACKGROUND
  Treatment of pediatric arteriovenous malformations (AVMs) is always a challenge considering their hemorrhagic presentation, associated morbidity and mortality, and the potential long life span of these children. Spetzler-Martin grades I-III are the grey zones as far as the treatment options are concerned. With a generous multimodality approach, one can reduce the morbidity and mortality to a considerable extent.
  
  
  OBJECTIVE
  To analyze the demographic and clinico-radiological profile of pediatric intracranial AVMs belonging to Spetzler-Martin grades I-III and their outcome following microsurgical excision.
  
  
  METHODS
  Pediatric patients (≤18 years of age) from a period of January 2001-January 2011 were included in the study. Patients with associated aneurysms or tumors were excluded from the study. Post-operative DSA/CT angiography was done within 6 weeks after surgery. Outcome was analyzed in terms of neurological improvement according to Medical Research Council Grade (MRC), obliteration of the AVM in post-operative angiography and Modified Rankin score. Outcome based on Modified Rankin score was favorable with a score of 0-2 and unfavorable when the score was 3-6.
  
  
  RESULTS
  A total of 36 patients with a mean follow-up of 12.75 months were identified. Thirty-one patients (86.1%) presented with hemorrhage while only 15 (41.6%) presented with seizures. There were 25 (69.4%) males and 11 (30.6%) females. Spetzler-Martin grade was grade I in six patients, grade II in 20 patients, and grade III in ten patients. All patients underwent surgical excision of the AVMs and post-operative angiography showed a 100% obliteration rate. There was a favorable outcome in 86.1% of the patients according to modified Rankin score.
  
  
  CONCLUSIONS
  The aim of treating a pediatric AVM should be complete obliteration of the AVM considering the high risk of hemorrhage and the morbidity and mortality associated with hemorrhage. With careful planning and adopting a multimodality treatment, complete obliteration can definitely be achieved.
authors.affiliation: Department of Neurosurgery, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow 226014, India.
authors.forename: Anup P
authors.initials: AP
authors.lastname: Nair
authors.forename: Raj
authors.initials: R
authors.lastname: Kumar
authors.forename: Anant
authors.initials: A
authors.lastname: Mehrotra
authors.forename: A K
authors.initials: AK
authors.lastname: Srivastava
authors.forename: Rabi Narayan
authors.initials: RN
authors.lastname: Sahu
authors.forename: Prakash
authors.initials: P
authors.lastname: Nair
mesh_terms: D000293:Adolescent; D002548:Cerebral Revascularization / Q000379:methods; D002648:Child; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D002538:Intracranial Arteriovenous Malformations / Q000000981:diagnostic imaging* / Q000601:surgery*; D008297:Male; D011859:Radiography; D012720:Severity of Illness Index; D016896:Treatment Outcome