Pediatric arteriovenous malformations: a 15-year experience with an emphasis on residual and recurrent lesions

Object Pediatric arteriovenous malformations (AVMs) are generally treated with microsurgical resection to achieve complete obliteration. We review our experience treating AVMs in children, particularly those with residual or recurrent lesions. Methods The records of 39 patients with AVMs (25 girls: 14 boys; average age 10.3 years) treated during a 15-year period were reviewed ( mean follow-up 30 months). Three primary outcomes were analyzed: AVM obliteration by last follow-up, residual on postoperative angiograms and recurrence after angiographic cure. Results Most children (57%) presented with spontaneous intracerebral hemorrhage, the average nidus size was 3.4 cm, and the modal Spetzler-Martin grade was 2. AVMs were classified as compact (82%) or diffuse (18%). Most patients (90%) underwent surgery as their primary treatment. The immediate obliteration rate was 76% and the overall, long-term obliteration rate was 89%. Nine (23%) patients had residual nidus after initial treatment; five of these underwent further treatment that obliterated their lesion. Five (13%) patients developed recurrence within 6 years, including one patient with two recurrences. Three were successfully treated with a repeat resection. Patients with diffuse-type AVMs were at greater risk of having a persistent lesion (40%), residual lesion (44%), or recurrence (80%) at last follow-up. Conclusion Most pediatric AVMs can be successfully treated with microsurgical resection. Endovascular treatment is reserved primarily as a preoperative adjunct and stereotactic radiosurgery for inoperable AVMs. Patients may develop recurrences years after their original treatment. Patients with diffuse-type AVMs were less likely to be cured and more likely to have a residual or a recurrence.