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Pediatric Arteriovenous Malformations

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Brain Arteriovenous Malformations

Abstract

Contrary to their embryological origin, cerebral arteriovenous malformations have traditionally been regarded as an adult disease. Among various types of congenital vascular disease, classified based on their histopathologic features, “true” arteriovenous malformations (AVM’s) are the most challenging in terms of treatment. Most AVMs present in adulthood, with a mean age of patients at presentation of approximately 30–40 years. Nevertheless, the previously reported incidence rates in population based studies are increasing most probably due to detection of asymptomatic cases. Especially availability and extensive utilization of the non-invasive, highly diagnostic magnetic resonance (MR) imaging almost as a screening test enabled to detect AVMs far before they become symptomatic. This is especially true for the pediatric cases; while in previously reported series consisting of mostly symptomatic cases less than 10% would be children, this percentage is almost doubled in more recent reports [1, 2]. Added the difficulties of treating immature child brain with diverse physiology and metabolism, increasing number of asymptomatic AVMs brings more challenge to decision making for treatment. Nevertheless, spontaneous intracerebral hemorrhage is far more common as the initial sign in pediatric population associated with higher morbidity and mortality [1]. This chapter focuses on unique properties of pediatric AVMs contributing the treatment of choice with various modalities.

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References

  1. Di Rocco C, Tamburrini G, Rollo M. Cerebral arteriovenous malformations in children. Acta Neurochir. 2000;142:145–56.

    Article  PubMed  Google Scholar 

  2. Smith ER, Scott RM. Pediatric patients with arteriovenous malformations: special considerations. In: Spetzler RF, Kondziolka DS, Higashida RT, Yashar M, Kalani S, editors. Comprehensive management of arteriovenous malformations of the brain and spine. Cambridge: Cambridge University Press; 2015. p. 313–9.

    Google Scholar 

  3. Yang W, Anderson-Keightly H, Westbroek EM, Caplan JM, et al. Long-term hemorrhagic risk in pediatric patients with arteriovenous malformations. J Neurosurg Pediatr. 2016;18(3):329–38.

    Article  PubMed  Google Scholar 

  4. Srinivasan VM, Gressot LV, Daniels BS, Jones JY, Jea A, Lam S. Management of intracerebral hemorrhage in pediatric neurosurgery. Surg Neurol Int. 2016;7:1121–6.

    Article  Google Scholar 

  5. Kondziolka D, Humphreys RP, Hoffman HJ, Hendrick EB, Drake JM. Arteriovenous malformations of the brain in children: a forty-year experience. Can J Neurol Sci. 1992;19:40–5.

    CAS  PubMed  Google Scholar 

  6. Darsaut TE, Guzman R, Marcellus ML, Edwards MS, Tian L, Do HM, et al. Management of pediatric intracranial arteriovenous malformations: experience with multimodality therapy. Neurosurgery. 2011;69:540–56.

    Article  PubMed  Google Scholar 

  7. Berman MF, Sciacca RR, Pile-Spellman J, Stapf C, Connolly ES Jr, Mohr JP, et al. The epidemiology of brain arteriovenous malformations. Neurosurgery. 2000;47:389–96.

    Article  CAS  PubMed  Google Scholar 

  8. Stapf C, Mast H, Sciacca RR, Berenstein A, Nelson PK, Gobin YP, et al. The New York Islands AVM Study: design, study progress, and initial results. Stroke. 2003;34(5):29–33.

    Article  Google Scholar 

  9. Laakso A, Dashti R, Seppanen J, Juvela S, Vaart K, Niemela M, et al. Long-term excess mortality in 623 patients with brain arteriovenous malformations. Neurosurgery. 2008;63(2):244–53.

    Article  PubMed  Google Scholar 

  10. Garza-Mercado R, Cavazos E, Tamez-Montez D. Cerebral arteriovenous malformations in children and adolescents. Surg Neurol. 1987;27:131–40.

    Article  CAS  PubMed  Google Scholar 

  11. Millar C, Bissonnette B, Humphreys RP. Cerebral arteriovenous malformations in children. Can J Anesth. 1994;41:321–31.

    Article  CAS  PubMed  Google Scholar 

  12. Boon LM, Mulliken JB, Vikkula M. RASA1: variable phenotype with capillary and arteriovenous malformations. Curr Opin Genet Dev. 2005;15:265–9.

    Article  CAS  PubMed  Google Scholar 

  13. Brinjikji W, Iyer VN, Wood CP, Lanzino G. Prevalence and characteristics of brain arteriovenous malformations in hereditary hemorrhagic telangiectasia: a systematic review and meta-analysis. J Neurosurg. 2016;21:1–9.

    Google Scholar 

  14. Lester J, Ruano-Calderón LA, González-Olhovich I. Wyburn-Mason syndrome. J Neuroimaging. 2005;15(3):284–5.

    Article  PubMed  Google Scholar 

  15. Humphreys RP, Hendrick BE, Hoffman HJ. Arteriovenous malformations of the brainstem in childhood. Childs Brain. 1984;11:1–11.

    CAS  PubMed  Google Scholar 

  16. Yasargil MG. AVM of the brain, clinical considerations, general and special operative techniques, surgical results, nonoperated cases, cavernous and venous angiomas, neuroanesthesia, Microneurosurgery, vol. Vol 3B. New York: Thieme; 1988.

    Google Scholar 

  17. Sure U, Butz N, Schlegel J, et al. Endothelial proliferation, neoangiogenesis, and potential de novo generation of cerebrovascular malformations. J Neurosurg. 2001;94:972–7.

    Article  CAS  PubMed  Google Scholar 

  18. Smith ER. Pediatric arteriovenous malformations. In: Leland Albright A, Pollack IF, David Adelson P, editors. Principles and practice of pediatric neurosurgery. 3rd ed. New York: Thieme; 2014.

    Google Scholar 

  19. Sonstein WJ, Kader A, Michelsen WJ, Llena JF, Hirano A, Casper D. Expression of vascular endothelial growth factor in pediatric and adult cerebral arteriovenous malformations: an immunocytochemical study. J Neurosurg. 1996;85:838–45.

    Article  CAS  PubMed  Google Scholar 

  20. Rothbart D, Awad IA, Lee J, Kim J, Harbaugh R, Criscuolo GR. Expression of angiogenic factors and structural proteins in central nervous system vascular malformations. Neurosurgery. 1996;38:915–24.

    Article  CAS  PubMed  Google Scholar 

  21. Kiliç T, Pamir MN, Küllü S, Eren F, Ozek MM, Black PM. Expression of structural proteins and angiogenic factors in cerebrovascular anomalies. Neurosurgery. 2000;46:1179–91.

    Article  PubMed  Google Scholar 

  22. Hashimoto T, Emala CW, Joshi S, et al. Abnormal pattern of Tie-2 and vascular endothelial growth factor receptor expression in human cerebral arteriovenous malformations. Neurosurgery. 2000;47:910–8.

    Article  CAS  PubMed  Google Scholar 

  23. Hetts SW, Su H, Tihan T, Hashimoto T, Pawlikowska L, Lawton MT. Development of the central nervous system vasculature and the pathogenesis of brain arteriovenous malformations. In: Spetzler RF, Kondziolka DS, Higashida RT, Yashar M, Kalani S, editors. Comprehensive management of arteriovenous malformations of the brain and spine. Cambridge: Cambridge University Press; 2015.

    Google Scholar 

  24. Ondra SO, Troupp H, George ED, Schwab K. The natural history of symptomatic arteriovenous malformations of the brain: a 24-year follow-up assessment. J Neurosurg. 1990;73:387–91.

    Article  CAS  PubMed  Google Scholar 

  25. Kahl W, Kessel G, Schwarz M, Voth D. Arterio-venous malformations in childhood: clinical presentation, results after operative treatment and long-term follow-up. Neurosurg Rev. 1989;12:165–71.

    Article  CAS  PubMed  Google Scholar 

  26. Celli P, Ferrante L, Palma L, Cavedon G. Cerebral arteriovenous malformations in children. Clinical features and outcome of treatment in children and in adults. Surg Neurol. 1984;22:43–9.

    Article  CAS  PubMed  Google Scholar 

  27. Fong D, Chan S. Arteriovenous malformation in children. Childs Nerv Syst. 1988;4:199–203.

    Article  CAS  PubMed  Google Scholar 

  28. Wilkins RH. Natural history of intracranial vascular malformations: a review. Neurosurgery. 1985;16:421–30.

    Article  CAS  PubMed  Google Scholar 

  29. Humphreys RP, Hendrick BE, Hoffman HJ. Arteriovenous malformations of the brain. Concepts Pediatr Neurosurg. 1988;8:146–64.

    Google Scholar 

  30. Millar C, Bissonette B, Humphreys RP. Cerebral arteriovenous malformations in children. Can J Anaesth. 1994;41(4):321–31.

    Article  CAS  PubMed  Google Scholar 

  31. Brown RD Jr, Wiebers DO, Forbes GS. Unruptured intracranial aneurysms and arteriovenous malformations: frequency of intracranial hemorrhage and relationship of lesions. J Neurosurg. 1990;73(6):859–63.

    Article  PubMed  Google Scholar 

  32. Yeh H-S, Kashiwagi S, Tew JM, Berger TS. Surgical management of epilepsy associated with cerebral arteriovenous malformations. J Neurosurg. 1990;72:216–23.

    Article  CAS  PubMed  Google Scholar 

  33. Crawford PM, West CR, Shaw MD, et al. Cerebral arteriovenous malformations and epilepsy: factors in the development of epilepsy. Epilepsia. 1986;27:270–5.

    Article  CAS  PubMed  Google Scholar 

  34. Turjman F, Massoud TF, Sayre JW, et al. Epilepsy associated with cerebral arteriovenous malformations: a multivariate analysis of angioarchitectural characteristics. AJNR Am J Neuroradiol. 1995;16:345–50.

    CAS  PubMed  Google Scholar 

  35. Englot DJ, Young WL, Han SJ, et al. Seizure predictors and control after microsurgical resection of supratentorial arteriovenous malformations in 440 patients. Neurosurgery. 2012;71:572–80.

    Article  PubMed  Google Scholar 

  36. Leblanc R, Feindel W, Ethier R. Epilepsy from cerebral arteriovenous malformations. Can J Neurol Sci. 1983;10(2):91–5.

    Article  CAS  PubMed  Google Scholar 

  37. Hurst RW, Hackney DB, Goldberg HI, Davis RA. Reversible arteriovenous malformation-induced venous hypertension as a cause of neurological deficits. Neurosurgery. 1992;30:422–5.

    Article  CAS  PubMed  Google Scholar 

  38. Rodesch G, Malherbe V, Alvarez H, et al. Nongalenic cerebral arteriovenous malformations in neonates and infants. Childs Nerv Syst. 1995;11:231–41.

    Article  CAS  PubMed  Google Scholar 

  39. Zerah M, Garcia-Monaco R, Rodesch G, Terbrugge K, Tardieu M, De Victor D, Lasjaunias P. Hydrodynamics in vein of Galen malformations. Childs Nerv Syst. 1992;8:111–7.

    Article  CAS  PubMed  Google Scholar 

  40. Andeweg J. Intracranial venous pressure, hydrocephalus and effects of cerebrospinal fluid shunts. Childs Nerv Syst. 1989;5:318–23.

    Article  CAS  PubMed  Google Scholar 

  41. Gobin YP, Laurent A, Merienne L, et al. Treatment of brain arteriovenous malformations by embolization and radiosurgery. J Neurosurg. 1996;85:19–28.

    Article  CAS  PubMed  Google Scholar 

  42. Wallace RC, Bourekas EC. Brain arteriovenous malformations. Neuroimaging Clin N Am. 1998;8(2):383–99.

    CAS  PubMed  Google Scholar 

  43. Hoang T, Hasso AN. Intracranial vascular malformations. Neuroimaging Clin N Am. 1994;4:823–47.

    CAS  PubMed  Google Scholar 

  44. Kucharczyk W, Lemme-Pleghos L, Uske A, Brant-Zawadski M, Dooms G, Norman D. Intracranial vascular malformations: MR and CT imaging. Neuroradiology. 1985;156:383–9.

    CAS  Google Scholar 

  45. Griffiths PD, Beveridge CJ, Gholkar A. Angiography in non-traumatic brain haematoma. An analysis of 100 cases. Acta Radiol. 1997;38:797–802.

    CAS  PubMed  Google Scholar 

  46. Willinsky RA, Fitzgerald M, TerBrugge K, Montanera W, Wallace M. Delayed angiography in the investigation of intracerebral hematomas caused by small arteriovenous malformations. Neuroradiology. 1993;35:307–11.

    Article  CAS  PubMed  Google Scholar 

  47. Kokkinis C, Vlychou M, Zavras GM, et al. The role of 3D-computed tomography angiography (3D-CTA) in investigation of spontaneous subarachnoid haemorrhage: comparison with digital subtraction angiography [DSA] and surgical findings. Br J Neurosurg. 2008;22:71–8.

    Article  CAS  PubMed  Google Scholar 

  48. Mikami T, Hirano T, Sugino T, et al. Presurgical planning for arteriovenous malformations using multidetector row CT. Neurosurg Rev. 2012;35:393–9.

    Article  PubMed  Google Scholar 

  49. Graves VB, Duff TA. Intracranial arteriovenous malformations: current imaging and treatment. Invest Radiol. 1990;25:952–60.

    Article  CAS  PubMed  Google Scholar 

  50. LeBlanc R, Levesque M, Comair Y, Ethier R. Magnetic resonance imaging of cerebral arteriovenous malformations. Neurosurgery. 1987;21:15–20.

    Article  CAS  PubMed  Google Scholar 

  51. Nussel F, Wegmuller H, Huber P. Comparison of magnetic resonance angiography, magnetic resonance imaging and conventional angiography in cerebral arteriovenous malformations. Neuroradiology. 1991;33:56–61.

    Article  CAS  PubMed  Google Scholar 

  52. Chaney RK, Taber KH, Orrison WW, Hayman LA. Magnetic resonance imaging of intracerebral hemorrhage at different field strengths. Neuroimaging Clin N Am. 1992;2:25–51.

    Google Scholar 

  53. Smith HJ, Strother CM, Kikuchi Y, et al. MR imaging in the management of supratentorial intracranial AVMs. Am J Roentgenol. 1988;150:1143–53.

    Article  CAS  Google Scholar 

  54. Orbach DB, Stamoulis C, Strauss KJ, et al. Neurointerventions in children: radiation exposure and its import. AJNR Am J Neuroradiol. 2014;35:650–6.

    Article  CAS  PubMed  Google Scholar 

  55. Al-Shahi Salman R, White PM, Counsell CE, et al. Outcome after conservative management or intervention for unruptured brain arteriovenous malformations. JAMA. 2014;311:1661–9.

    Article  PubMed  Google Scholar 

  56. Mohr JP, Parides MK, Stapf C, et al. Medical management with or without interventional therapy for unruptured brain arteriovenous malformations (ARUBA): a multicentre, non-blinded, randomised trial. Lancet. 2014;383:614–21.

    Article  CAS  PubMed  Google Scholar 

  57. Spetzler RF, Martin NA. A proposed grading system for arteriovenous malformations. J Neurosurg. 1986;65:476–83.

    Article  CAS  PubMed  Google Scholar 

  58. Greenfield JP, Souweidane MM. Diagnosis and management of pediatric arteriovenous malformations. In: Stieg PE, Hunt Batjer H, Samson D, editors. Intracranial arteriovenous malformations. New York: Informa Healthcare USA, Inc.; 2007. p. 359–70.

    Google Scholar 

  59. Klimo P Jr, Rao G, Brockmeyer D. Pediatric arteriovenous malformations: a 15-year experience with an emphasis on residual and recurrent lesions. Childs Nerv Syst. 2007;23:31–7.

    Article  PubMed  Google Scholar 

  60. Bristol RE, Albuquerque FC, Spetzler RF, et al. Surgical management of arteriovenous malformations in children. J Neurosurg. 2006;105:88–93.

    Article  PubMed  Google Scholar 

  61. Hoh BL, Ogilvy CS, Butler WE, et al. Multimodality treatment of nongalenic arteriovenous malformations in pediatric patients. Neurosurgery. 2000;47:346–57.

    Article  CAS  PubMed  Google Scholar 

  62. Kiris T, Sencer A, Sahinbas M, et al. Surgical results in pediatric Spetzler-Martin grades I–III intracranial arteriovenous malformations. Childs Nerv Syst. 2005;21:69–74.

    Article  PubMed  Google Scholar 

  63. Sanchez-Mejia RO, Chennupati SK, Gupta N, et al. Superior outcomes in children compared with adults after microsurgical resection of brain arteriovenous malformations. J Neurosurg Pediatr. 2006;105(2):82–7.

    Article  Google Scholar 

  64. Ferch RD, Morgan MK. High-grade arteriovenous malformations and their management. J Clin Neurosci. 2002;9(1):37–40.

    Article  PubMed  Google Scholar 

  65. Luessenhop AJ, Rosa L. Cerebral arteriovenous malformations. Indications for and results of surgery and the role of intravascular techniques. J Neurosurg. 1984;60:14–22.

    Article  CAS  PubMed  Google Scholar 

  66. Guo WY, Lindquist C, Karlsson B, et al. Gamma knife surgery of cerebral arteriovenous malformations: serial MR imaging studies after radiosurgery. Int J Radiat Oncol Biol Phys. 1993;25:315–23.

    Article  CAS  PubMed  Google Scholar 

  67. Jeffrey P, Blount R, Shane Tubbs PA-C, Jerry Oakes W, Humphreys RP. History of surgery for cerebrovascular disease in children. Part III. Arteriovenous malformations. Neurosurg Focus. 2006;20(6):E11.

    Google Scholar 

  68. Lasjaunias P, Hui F, Zerah M, et al. Cerebral arteriovenous malformations in children. Management of 179 consecutive cases and review of the literature. Childs Nerv Syst. 1995;11:66–79.

    Article  CAS  PubMed  Google Scholar 

  69. Dawson RC III, Tarr RW, Hecht ST, et al. Treatment of arteriovenous malformations of the brain with combined embolization and stereotactic radiosurgery: results after 1 and 2 years. AJNR Am J Neuroradiol. 1990;11:857–64.

    PubMed  Google Scholar 

  70. Dion JE, Mathis JM. Cranial arteriovenous malformations: the role of embolization and stereotactic surgery. Neurosurg Clin N Am. 1994;5:459–74.

    CAS  PubMed  Google Scholar 

  71. Ogilvy CS, Stieg PE, Awad I, Brown RD Jr, Kondziolka D, Rosenwasser R, et al. AHA Scientific Statement. Recommendations for the management of intracranial arteriovenous malformations: a statement for healthcare professionals from a special writing group of the Stroke Council, American Stroke Association. Circulation. 2001;103:2644–57.

    Article  CAS  PubMed  Google Scholar 

  72. Steinberg GK, Fabrikant JI, Marks MP, et al. Stereotactic helium ion Bragg peak radiosurgery for intracranial arteriovenous malformations. Detailed clinical and neurologic outcome. Stereotact Funct Neurosurg. 1991;57:36–49.

    Article  CAS  PubMed  Google Scholar 

  73. Pollock BE, Gorman DA, Brown PD. Radiosurgery for arteriovenous malformations of the basal ganglia, thalamus, and brainstem. J Neurosurg. 2004;100:210–4.

    Article  PubMed  Google Scholar 

  74. Pollock BE, Gorman DA, Coffey RJ. Patient outcome after arteriovenous malformation radiosurgical management: results based on a 5- to 14-year follow-up study. Neurosurgery. 2003;52:1291–7.

    Article  PubMed  Google Scholar 

  75. Altschuler EM, Lunsford LD, Coffey RJ, Bissonette DJ, Flickinger JC. Gamma knife radiosurgery for intracranial arteriovenous malformations in childhood and adolescence. Pediatr Neurosci. 1989;15:53–61.

    Article  CAS  PubMed  Google Scholar 

  76. Cohen-Gadol AA, Pollock BE. Radiosurgery for arteriovenous malformations in children. J Neurosurg. 2006;104(6 Suppl):388–91.

    PubMed  Google Scholar 

  77. Pan DH, Kuo YH, Guo WY, Chung WY, Wu HM, Liu KD, et al. Gamma Knife surgery for cerebral arteriovenous malformations in children: a 13-year experience. J Neurosurg Pediatr. 2008;1:296–304.

    Article  PubMed  Google Scholar 

  78. Reyns N, Blond S, Gauvrit JY, Touzet G, Coche B, Pruvo JP, et al. Role of radiosurgery in the management of cerebral arteriovenous malformations in the pediatric age group: data from a 100-patient series. Neurosurgery. 2007;60:268–76.

    Article  PubMed  Google Scholar 

  79. Starke RM, Ding D, Kano H, Mathieu D, Huang PP, Feliciano C, Rodriguez-Mercado R, Almodovar L, Grills IS, Silva D, Abbassy M, Missios S, Kondziolka D, Barnett GH, Dade Lunsford L, Sheehan JP. International multicenter cohort study of pediatric brain arteriovenous malformations. Part 2: Outcomes after stereotactic radiosurgery. J Neurosurg Pediatr. 2017;19(2):136–48.

    Article  PubMed  Google Scholar 

  80. Barrow DL. Controversies in neurosurgery: microsurgery versus radiosurgery for arteriovenous malformations—the case for microsurgery. Clin Neurosurg. 2000;46:285–94.

    CAS  PubMed  Google Scholar 

  81. Fleetwood IG, Steinberg GK. Arteriovenous malformations. Lancet. 2002;359:863–73.

    Article  PubMed  Google Scholar 

  82. Foote KD, Friedman WA, Ellis TL, et al. Salvage retreatment after failure of radiosurgery in patients with arteriovenous malformations. J Neurosurg. 2003;98:337–41.

    Article  PubMed  Google Scholar 

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Başak, N.Ç., Akalan, N. (2017). Pediatric Arteriovenous Malformations. In: Beneš, V., Bradáč, O. (eds) Brain Arteriovenous Malformations. Springer, Cham. https://doi.org/10.1007/978-3-319-63964-2_15

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