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A comparison of incidental and symptomatic unruptured brain arteriovenous malformations in children.
Lu, Alex Y; Winkler, Ethan A; Garcia, Joseph H; Raygor, Kunal P; Fullerton, Heather J; Fox, Christine K; Kim, Helen; Auguste, Kurtis I; Sun, Peter P; Hetts, Steven W; Lawton, Michael T; Abla, Adib A; Gupta, Nalin.
Afiliação
  • Lu AY; Departments of1Neurological Surgery.
  • Winkler EA; 2Department of Neurosurgery, Barrow Neurological Institute, Phoenix, Arizona.
  • Garcia JH; Departments of1Neurological Surgery.
  • Raygor KP; Departments of1Neurological Surgery.
  • Fullerton HJ; 3Department of Neurology, Pediatric Stroke and Cerebrovascular Disease Center, University of California, San Francisco, California; and.
  • Fox CK; 3Department of Neurology, Pediatric Stroke and Cerebrovascular Disease Center, University of California, San Francisco, California; and.
  • Kim H; 4Department of Anesthesia and Perioperative Care, Center for Cerebrovascular Research, University of California, San Francisco, California.
  • Auguste KI; Departments of1Neurological Surgery.
  • Sun PP; Departments of1Neurological Surgery.
  • Hetts SW; 5Radiology and Biomedical Imaging, and.
  • Lawton MT; 2Department of Neurosurgery, Barrow Neurological Institute, Phoenix, Arizona.
  • Abla AA; Departments of1Neurological Surgery.
  • Gupta N; Departments of1Neurological Surgery.
J Neurosurg Pediatr ; 31(5): 463-468, 2023 05 01.
Article em En | MEDLINE | ID: mdl-36805316
ABSTRACT

OBJECTIVE:

Patients with unruptured brain arteriovenous malformations (AVMs) may present with headaches, seizures, and/or neurological deficits. A smaller number of cases may be discovered incidentally. These lesions remain incompletely understood due to their sparse reporting. Herein, the authors describe the largest series to date comparing the presentation, angioarchitecture, and management of incidental versus symptomatic unruptured AVMs in children.

METHODS:

The authors performed a retrospective analysis of patients who presented with brain AVMs from 1998 to 2022 at the University of California, San Francisco. Inclusion criteria were age ≤ 18 years at the time of presentation and an angiographically proven unruptured AVM that had been diagnosed postnatally.

RESULTS:

Of 76 children with unruptured AVMs, 66 (86.8%) presented with headaches, seizures, and/or neurological deficit. Ten AVMs (13.1%) were incidentally discovered through unrelated disease workup (50%), cranial trauma (40%), or research study participation (10%). Compared with patients with symptomatic unruptured AVMs, patients with incidental unruptured AVMs had a smaller mean ± SD maximum nidus diameter (2.82 ± 1.1 vs 3.98 ± 1.52 cm, p = 0.025) and fewer had deep venous drainage (20% of patients vs 61%, p = 0.036). They also presented at an earlier age (10 ± 5.2 vs 13.5 ± 4 years, p = 0.043) and with longer duration to first treatment (541 ± 922 vs 196 ± 448 days, p = 0.005). During the observation period, 1 patient developed recurring headaches and demonstrated AVM nidus growth. Four AVMs greater than 3 cm in size or in a deep location were treated with radiosurgery. Six other AVMs were treated with resection, with 2 receiving preoperative embolization. Eight AVMs (80%) were obliterated on last follow-up. Postprocedural complications included 2 transient neurological deficits after resection and 1 case of delayed seizure development after radiosurgery. The mean follow-up period was 5.7 ± 5.7 years without any hemorrhage episodes.

CONCLUSIONS:

A substantial proportion of pediatric patients with unruptured AVMs are discovered incidentally. With earlier presentation and more elementary angioarchitecture than symptomatic unruptured AVMs, these incidental lesions provide a snapshot into the natural history of AVM before symptom development or rupture.
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Texto completo: 1 Base de dados: MEDLINE Assunto principal: Malformações Arteriovenosas Intracranianas / Radiocirurgia / Malformações do Sistema Nervoso Idioma: En Ano de publicação: 2023 Tipo de documento: Article

Texto completo: 1 Base de dados: MEDLINE Assunto principal: Malformações Arteriovenosas Intracranianas / Radiocirurgia / Malformações do Sistema Nervoso Idioma: En Ano de publicação: 2023 Tipo de documento: Article