Long-term outcomes in pediatric unruptured brain arteriovenous malformation treated by nonconservative management: a single center analysis

Abstract

Purpose: The best management of pediatric unruptured brain arteriovenous malformations (ubAVM) should be further elucidated.

Methods: Pediatric patients who presented to our facility with ubAVM and were treated nonconservatively were retrospectively analyzed regarding demographics, presenting symptoms, AVM characteristics, treatment modality, and outcome.

Results: Thirteen patients were included. There were 9 male and 4 female patients with an average age (± SD) of 7.8 ± 4.6 years. The most common presenting symptom was seizure. The mean Spetzler Martin (SM) grade was 3.2. Seven patients were treated by surgical excision, 8 by embolization, 6 by radiosurgery, and during the mean follow-up period of 8.9 years (2.6-14.4 years), there were no hemorrhage. Complete ubAVM obliteration was achieved in all 7 patients (100%) who underwent surgical excision. AVM was obliterated in 5 out of 9 patients whose SM grade was 3 or 4. Modified Rankin scale was good (mRS 0-2) in all 13 patients.

Conclusions: Since the lifetime hemorrhage rate of pediatric ubAVM is high, it may be better to proceed with nonconservative treatment, especially when surgical excision is amenable. Nonconservative treatment could be an appropriate treatment with acceptable neurological outcome even in those with moderate to high-grade AVMs in selected cases.

Keywords: Brain arteriovenous malformation; Nonconservative management; Unruptured AVM.