Different treatment methods and prognostic analysis of cerebral arteriovenous malformation in children

Abstract

Objective To investigate the optimal clinical therapy effects and prognostic factors of cerebral arteriovenous malformation (CAVM) in children following different treatment methods. Methods The clinical data of 47 children (< 18 years old) with CAVM who were admitted to Tianjin Huanhu Hospital from October 2011 to September 2022 were collected, and the multimodality treatment and prognostic factors of different grades were analyzed. Spetzler - Martin grading system and vascular nest dispersion classification were used to evaluate the risk and angiogenesis of CAVM, different treatment modalities such as microsurgery, gamma knife radiosurgery, and multi-mode therapy were used to evaluate the total resection rate, prognosis, and imaging follow-up results. Results 1) Treatment plan: among the total 47 children in this group, 35 (74.47%) received simple microsurgery, of which 10 (28.57%) suffered surgery within one week of hemorrhage, and 25 (71.43%) suffered surgery over one week; 6 (12.77%) received conservative treatment; 3 (6.38%) received gamma knife radiosurgery; 3 (6.38%) received multimodal therapy (microsurgery + interventional embolism/gamma knife radiosurgery). 2) Spetzler - Martin grading and prognosis: among the 38 patients (80.85%) of Spetzler - Martin grade Ⅰ - Ⅲ , 29 (76.32%) underwent microsurgery, one (2.63%) received multimodal therapy, and 2 (5.26%) received gamma knife radiosurgery. The total surgical resection rate was 9/9 in grade Ⅰ, 13/14 in grade Ⅱ and 6/9 in grade Ⅲ. Eight patients (21.05%) had a poor prognosis during 5 years followed-up period. There was one (2.63%) recurrence on imaging follow-up. Among 9 patients whose Spetzler-Martin grade were between Ⅳ and Ⅴ , 6 patients underwent microsurgery, 2 patients received multimodal therapy, and one received gamma knife radiosurgery. Total surgical resection rate was 4/8 in grade Ⅳ and 1/1 in grade Ⅴ, and prognosis was poor in 5 cases. 3) Diffusion classification and prognosis of malformed vascular mass: the total resection rate of dense type was 17/17, and that of diffuse type was 66.67% (16/24). The incidence of poor prognosis was 3/ 18 for dense type and 34.48% (10/29) for diffuse type. Conclusions Microsurgery resection is a relatively safe and effective method for the treatment of CAVM in children. The operation was recommended to be performed at least one week after acute hemorrhage if possible. A preoperative evaluation of surgical risks and the density of abnormal vascular clusters can assist in selecting the best treatment plan, thus could increase the total resection rate of lesions and improve the prognosis.

Keywords

• intracranial arteriovenous malformations
• microsurgery
• embolism
• radiosurgery
• cerebral angiography
• child