A retrospective analysis of 62 children with cerebral arteriovenous malformations (AVM) seen over 17 years is reported from Hospital B, Lille, France.
A retrospective analysis of 62 children with cerebral arteriovenous malformations (AVM) seen over 17 years is reported from Hospital B, Lille, France. Ages ranged from 3 months to 14 years. Seven had a previous history of headache, and 5 (8%) had been treated for epilepsy. Intracranial hemorrhage and stroke was the presenting manifestation in 54 (87%). AVMs were supratentorial in 41 and infratentorial in 11. Total excision of the AVM was achieved in 47 of 52 operated. At follow-up, 50 had a good clinical outcome based on the Glasgow scale, 6 mild, 2 poor, and 4 died. Recurrent hemorrhage occurred in 3, fatal in 1. AVM recurrences in 2 were treated successfully by radiosurgery. Of ten with aphasia before surgery; 5 had improved. Of 25 with hemiparesis on admission, 12 recovered function and 7 have severe deficits. Two developed deficits after surgery. Of 7 with residual epilepsy after surgery, 6 are controlled with AEDs. [
COMMENT. In reviewing the literature the authors report a postoperative mortality in children ranging from 8.5% to 11%, versus 23% to 57% following conservative management. Surgery is considered the most reliable treatment, combining teams experienced in neurosurgery, embolization, and radiosurgery. The smaller the AVM, the higher the risk of hemorrhage, and the greater the indication for surgery after diagnosis is established. The authors view angiography as superior to CT and MRI in diagnosis and management of AVM. Postoperative angiography after 2 years is advised to exclude enlarging residual microshunts or recurrence of AVM.