1 - Department of Neuroradiology, Centro Hospitalar e Universitário de Lisboa Central, Lisbon, Portugal
2 - Department of Pediatric Neurology, Centro Hospitalar e Universitário de Lisboa Central, Lisbon, Portugal
3 - Department of Neurosurgery, Centro Hospitalar e Universitário de Lisboa Central, Lisbon, Portugal
- XVII Congresso da SPNR, 25 e 26 de Novembro de 2022, Lisboa
Introduction: 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 work is to review our experience with endovascular treatment of bAVMs in pediatric patients, considering both efficacy and safety outcomes.
Material and Methods: Retrospective analysis of all bAVMs in pediatric patients (0-18 years) who underwent digital subtraction angiography (DSA) at our institution from January 2010 to June 2022.
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 female: seven (58%) were treated in a single session and the remaining in multiple sessions (range 1-5 per patient). Complete angiographic exclusion was achieved in 5 (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 lesion. 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 were independent at follow-up (modified Rankin scale score 0-2).
Conclusions: 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 undergo continuous vascular remodeling and may show recurrence over time, especially in the pediatric population.
Keywords: Brain arteriovenous malformations; pediatrics; children; endovascular treatment