gms | German Medical Science

62. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC)
Joint Meeting mit der Polnischen Gesellschaft für Neurochirurgen (PNCH)

Deutsche Gesellschaft für Neurochirurgie (DGNC) e. V.

07. - 11. Mai 2011, Hamburg

Experience with pediatric arteriovenous malformations

Meeting Abstract

  • M. Reitz - Klinik und Poliklinik für Neurochirurgie, Universitätsklinikum Hamburg Eppendorf, Hamburg
  • N.O. Schmidt - Klinik und Poliklinik für Neurochirurgie, Universitätsklinikum Hamburg Eppendorf, Hamburg
  • U. Grzyska - Neuroradiologische Abteilung, Klinik für Radiologie, Universitätsklinikum Hamburg Eppendorf
  • J. Fiehler - Neuroradiologische Abteilung, Klinik für Radiologie, Universitätsklinikum Hamburg Eppendorf
  • M. Westphal - Klinik und Poliklinik für Neurochirurgie, Universitätsklinikum Hamburg Eppendorf, Hamburg
  • J. Regelsberger - Klinik und Poliklinik für Neurochirurgie, Universitätsklinikum Hamburg Eppendorf, Hamburg

Deutsche Gesellschaft für Neurochirurgie. Polnische Gesellschaft für Neurochirurgen. 62. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC), Joint Meeting mit der Polnischen Gesellschaft für Neurochirurgen (PNCH). Hamburg, 07.-11.05.2011. Düsseldorf: German Medical Science GMS Publishing House; 2011. DocMO.10.07

DOI: 10.3205/11dgnc072, URN: urn:nbn:de:0183-11dgnc0723

Veröffentlicht: 28. April 2011

© 2011 Reitz et al.
Dieser Artikel ist ein Open Access-Artikel und steht unter den Creative Commons Lizenzbedingungen (http://creativecommons.org/licenses/by-nc-nd/3.0/deed.de). Er darf vervielfältigt, verbreitet und öffentlich zugänglich gemacht werden, vorausgesetzt dass Autor und Quelle genannt werden.


Gliederung

Text

Objective: Cerebral arteriovenous malformations (AVMs) are believed to be congenital vascular lesions. However, true recurrences are increasingly being reported and may reflect a more dynamic nature than previously thought. Our attention was focused on the subgroup of pediatric AVMs, for which therapy must prevent rebleeding lifelong.

Methods: Out of a series of 474 patients with intracranial AVMs, 49 children under the age of 16 were retrospectively analyzed for clinical, radiological and therapeutic features. Treatment strategies included (solely or combined) neurosurgical resection, endovacular embolization and/or radiosurgery. The primary goal was to achieve a complete resection confirmed by routine postoperative angiography.

Results: The most frequent clinical episodes leading to initial diagnosis were intracerebral hemorrhage (65%) and seizures (16%). In 45% (n=22), AVMs presented with complex features such as extensive size, flow-associated aneurysms, or localization in basal ganglia or the thalamic or callosal region. Microsurgical resection alone or with prior embolization was performed in 36 children. Curative embolization or radiosurgery was performed in 7 patients, whereas 6 patients refused therapy or invasive treatment was not recommended. Follow-up angiography verified complete obliteration in 35 AVMs (81%). In eight patients (19%), residual AVM was seen in the follow-up angiography. A further "wait and see" strategy was chosen in case of low-flow or small-sized residual AVMs accompanied by a markedly diminished venous drainage. Three patients developed a spontaneous obliteration under this regimen, the other 5 patients were operated a second time. AVM recurrence was seen in three patients (9%), in whom initial postoperative angiography had shown a complete resection.

Conclusions: Our data suggest a high rate of AVM regrowth in children, in whom one postoperative follow-up angiography appears not to be sufficient to secure a long-lasting, successful regimen. Spontaneous obliteration of a recurrent AVM as well as AVM regrowth and secondary arterialization may be seen, making a careful follow-up including repeated angiography after 3, 6 and 24 months mandatory.