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J Neurol Surg A Cent Eur Neurosurg
DOI: 10.1055/s-0043-1770356
Original Article

Endovascular Treatment of Brain Arteriovenous Malformations in Pediatric Patients: A Single Center Experience and Review of the Literature

Gonçalo Borges de Almeida 
1   Department of Neuroradiology, Centro Hospitalar e Universitário de Lisboa Central, Lisboa, Portugal
,
Jaime Pamplona
1   Department of Neuroradiology, Centro Hospitalar e Universitário de Lisboa Central, Lisboa, Portugal
2   NOVA Medical School, Universidade Nova de Lisboa, Portugal
,
Mariana Baptista
1   Department of Neuroradiology, Centro Hospitalar e Universitário de Lisboa Central, Lisboa, Portugal
2   NOVA Medical School, Universidade Nova de Lisboa, Portugal
,
Rui Carvalho
1   Department of Neuroradiology, Centro Hospitalar e Universitário de Lisboa Central, Lisboa, Portugal
2   NOVA Medical School, Universidade Nova de Lisboa, Portugal
,
Carla Conceição
1   Department of Neuroradiology, Centro Hospitalar e Universitário de Lisboa Central, Lisboa, Portugal
,
Rita Lopes da Silva
3   Department of Pediatric Neurology, Centro Hospitalar e Universitário de Lisboa Central, Lisboa, Portugal
,
Amets Sagarribay
4   Department of Neurosurgery, Centro Hospitalar e Universitário de Lisboa Central, Lisboa, Portugal
,
João Reis
1   Department of Neuroradiology, Centro Hospitalar e Universitário de Lisboa Central, Lisboa, Portugal
,
Isabel Fragata
1   Department of Neuroradiology, Centro Hospitalar e Universitário de Lisboa Central, Lisboa, Portugal
2   NOVA Medical School, Universidade Nova de Lisboa, Portugal
› Author Affiliations Funding None.
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Abstract

Background Brain arteriovenous malformations (bAVMs) are abnormal vascular connections with direct arteriovenous shunts, generally symptomatic in the adult life. However, a small number of bAVMs may manifest in pediatric patients, with higher bleeding risk and mortality rates when compared to adults. The purpose of this study is to review our experience with endovascular treatment of bAVMs in pediatric patients.

Methods This is a retrospective analysis of all bAVMs in pediatric patients (0–18 years) who underwent diagnostic digital subtraction angiography (DSA) at our institution from January 2010 to June 2021.

Results Twenty-six patients met the inclusion criteria, of which 12 underwent endovascular treatment. Treated patients had a mean age of 10.25 years and 58% were females. Complete angiographic exclusion was achieved in five (42%) patients with endovascular treatment. Five patients with residual bAVM after embolization needed adjuvant therapy with surgery (n = 3) or stereotactic radiosurgery (SRS; n = 2). Two patients are still undergoing embolization sessions. Procedure-related complications occurred in two patients (17%) and included small vessel perforation and an occipital ischemic stroke. Two patients showed bAVM recurrence on follow-up (17%) and subsequently underwent SRS (n = 1) or surgery (n = 1), both resulting in complete bAVM exclusion. All patients had a modified Rankin scale (mRS) score of 0 to 2 on follow-up.

Conclusion Our experience supports the effectiveness and safety of endovascular treatment of bAVM in selected pediatric patients. A multidisciplinary approach combining surgery and SRS is warranted to achieve higher complete bAVM obliteration rates. Long-term follow-up is important as these lesions may show recurrence over time, especially in the pediatric population.

Keywords

pediatric brain arteriovenous malformations - intracranial hemorrhage - endovascular embolization


Publication History

Received: 12 October 2022

Accepted: 13 March 2023

Article published online:
26 July 2023

© 2023. Thieme. All rights reserved.

Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany

 

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