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57th Annual Meeting of the German Society of Neurosurgery
Joint Meeting with the Japanese Neurosurgical Society

German Society of Neurosurgery (DGNC)

11 - 14 May, Essen

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Cerebral arteriovenous malformations in children – report of 41 cases

Zerebrale arteriovenöse Malformationen im Kindesalter – Studie von 41 Patienten

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  • corresponding author J. Regelsberger - Neurochirurgische Klinik, Universitätsklinikum Eppendorf, Hamburg
  • U. Grzyska - Neuroradiologische Abteilung, Universitätsklinikum Eppendorf, Hamburg
  • N.O. Schmidt - Neurochirurgische Klinik, Universitätsklinikum Eppendorf, Hamburg
  • G. Kammler - Neurochirurgische Klinik, Universitätsklinikum Eppendorf, Hamburg
  • H. Zeumer - Neuroradiologische Abteilung, Universitätsklinikum Eppendorf, Hamburg
  • M. Westphal - Neurochirurgische Klinik, Universitätsklinikum Eppendorf, Hamburg

Deutsche Gesellschaft für Neurochirurgie. Japanische Gesellschaft für Neurochirurgie. 57. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie e.V. (DGNC), Joint Meeting mit der Japanischen Gesellschaft für Neurochirurgie. Essen, 11.-14.05.2006. Düsseldorf, Köln: German Medical Science; 2006. DocSA.02.04

The electronic version of this article is the complete one and can be found online at: http://www.egms.de/en/meetings/dgnc2006/06dgnc090.shtml

Published: May 8, 2006

© 2006 Regelsberger et al.
This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by-nc-nd/3.0/deed.en). You are free: to Share – to copy, distribute and transmit the work, provided the original author and source are credited.

Outline

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Objective: Arteriovenous malformations (AVM) are believed to be congenital lesions but a de novo appearance is being increasingly reported and indicates a more dynamic nature than previously thought. In this context our attention has been focused on pediatric AVMs where therapy is intended to prevent rebleeding for life.

Methods: Out of a series of 424 AVM, 41 children under the age of 16 years, were retrospectively analyzed for their clinical, radiological and therapeutic features. Primary goal of therapy was complete resection with or without the combination of endovascular embolization or radiosurgery. Postoperative angiography was performed in all patients routinely.

Results: Intracerebral haemorrhage (61%) and seizures (17%) were the most frequent clinical episodes leading to the diagnosis of AVM. Complex therapeutic aspects of extensive size, flow associated aneurysms, location in the basal ganglia, thalamic or callosal region were found in 17 (41%) patients. Surgical resection with prior embolization or surgery alone was performed in 30 children. Curative embolization or radiosurgery was done in five patients whereas six patients refused therapy or treatment was not recommended. At control angiography, residual AVM was found in seven of 35 (20%) patients. Four underwent a second surgery whereas spontaneous obliteration was seen in the other three cases on further follow-up. Recurrent AVM was found in three patients where initial postoperative control angiography had excluded residual AVM. Time to recurrence in these patients ranged between 6 months and 7 years.

Conclusions: Our data indicates a high rate of true AVM recurrences in children where one postoperative control angiography is not sufficient to eliminate the risk of rebleeding. Spontaneous obliteration may be found in these cases as well. We believe that AVM therapy remains an interdisciplinary approach but most challenging especially in children where follow-up should routinly include a second angiography and further yearly MRI studies to ensure a curative result.