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Comparative outcome of endovascular embolization with microsurgery in managing acute spontaneous cerebral hemorrhage in pediatric patients, an institutional experience

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Abstract

Objectives

A few previous studies have reported the role of embolization with curative intent in the treatment of the early phase of a spontaneous cerebral hemorrhage in pediatric patients, and its efficacy needs to be compared with surgery at the same time risk factors for hemorrhage following early embolization in such patients need to be evaluated.

Methods

From a pool of 80 pediatric (< 18 years) who had undergone treatment for ruptured AVM with hemorrhage at our center between July 2018 and July 2022, we identified 36 patients with spontaneous bleeding due to AVM. Out of which, 20 were treated solely by embolization (group 1), while the remaining patients were treated surgically (with and without adjuvant embolization) (group 2).

Result

Spetzler-Martin’s grading of the lesion suggested seven lesions < 3 and 13 lesions ≥ 3 in the embolization group. Similarly, seven lesions were < 3 and nine ≥ 3 Spetzler-Martin grade in the surgery group. Incomplete embolization was associated with hemorrhage in two patients treated with curative intent and four patients treated with embolization as adjuvant in the surgery group (p = 0.01). On follow-up, 18 patients in the embolization group and 12 in the surgery group had Glasgow outcome scores ≥ 4 (p = 0.273).

Conclusion

In the pediatric age group, incomplete embolization is the significant risk factor for hemorrhage in AVMs treated after a hemorrhagic stroke. Embolization with curative intent is as effective as surgery in treating such lesions as adjuvant embolization with careful patient selection.

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Authors and Affiliations

  1. Department of Neurosurgery, All India Institute of Medical Sciences, Patna, Bihar, India

    Vikas Chandra Jha, Mohammad Shahnawaz Alam & Vivek Sharan Sinha

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  1. Vikas Chandra Jha
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Contributions

Conceptualization, clinical work, data collection, data analysis, manuscript drafting, and revision had been done by VCJ. Data collection and analysis had been done by VCJ, MSA, and VSS. Data analysis and manuscript supervision was done by VCJ, MSA, and VSS. All the authors have read and approved the final version of the manuscript. This manuscript has neither been presented as a whole nor as part of any conference or scientific meeting. This article is neither published nor under consideration for publication anywhere else.

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Correspondence to Vikas Chandra Jha.

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Written informed consent was taken from patients/relatives at the time of admission to use their data for teaching and research. Approval of the institutional ethical committee with approval no. IEC/2021/1243 was taken to conduct this study.

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Jha, V.C., Alam, M.S. & Sinha, V.S. Comparative outcome of endovascular embolization with microsurgery in managing acute spontaneous cerebral hemorrhage in pediatric patients, an institutional experience. Childs Nerv Syst 39, 963–974 (2023). https://doi.org/10.1007/s00381-022-05785-0

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