Endovascular management of pediatric cerebral arteriovenous malformations (AVMs)

Abstract

Cerebral AVMs are congenital vascular abnormalities composed of multiple fistulous connections between arteries & veins without the presence of a normal intervening capillary bed. AVMs in the pediatric population represent 3% of all AVMs. They are usually presented by spontaneous intracerebral haemorrhage followed by recurrent attacks of seizures, intractable headaches, and focal neurological deficits. Several imaging techniques are used for obtaining diagnosis including brain CT scan, CT angiography, MRI, MRA, and DSA. Regarding the management process, several modalities are currently used including conservative management, endovascular therapy (EVT), microsurgery, and stereotactic radiosurgery (SRS). EVT has been proven to be an effective and safe modality for treating cerebral AVMs in the pediatric population showing a high cure rate either as a single treatment modality or as a pre-procedural technique. Despite good post-embolization angiographic and clinical outcomes during the early follow-up period, still longer angiographic and clinical follow-ups are needed for all cases.