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.