gms | German Medical Science

Objective: Intracranial arteriovenous malformation (AVM) is seen in children and adults. While pediatric patients present more likely with hemorrhage it remains unclear whether this affects neurological outcome. In this study we reviewed a consecutive series of pediatric and adult patients from one center to determine differences in neurological outcome, hemorrhage rates, treatment modalities and AVM anatomy as seen by other groups.

Methods: During a 16 year period 46 pediatric and 112 adult patients (matched to SM-grade) undergoing AVM treatment were compared for clinical presentations, angioarchitectural features, treatment regimens and neurological outcome using the modified Rankin Score (mRS). Curative treatment modalities consisted of microsurgical resection with or without preoperative embolization as well as embolization alone or radiation were chosen in palliative cases.

Results: 46 pediatric and 112 adult patients with a mean age of 12.4 years (8-14 years) in the pediatric and mean age of 42.5 years (18-82 years) in the adult cohort were analyzed. 67.4% of children and 43.2% of adults presented with hemorrhage (p = 0.006). Adult AVMs harbored more drainage veins (p = 0.005) that were more likely dilated (p = 0.016). Treatment regimes did not differ between the two groups (p = 0.115), 42,5% of children and 33,9% of adults were solely operated, while 27,6% of children and 20,5% of adults obtained combined approaches. Other treatment regimens included embolization, radiation or just radiological control. Complete resection through operation alone was achieved in 92,3% of children (n=13) and 74,5% of adults (n=29), while combined approaches showed a complete occlusion in 84,6% children (n=13) and 80% in adults (n=20). Patients presenting in a good clinical outcome (mRS 0-1) showed no significant difference between the two age groups.

Conclusion: Even though children are more likely to present with hemorrhage than their adult counterparts, they do not present worse in their long-term follow-up after treatment. In this context, children also showed a better post-intervention control of the disease. These findings lead the authors to conclude that children may have a greater neural capacity, possibly justifying aggressive treatment measures reaching the goal of AVM cure via complete extirpation.