Arteriovenous malformation surgery in children: the Rady Children's Hospital experience (2002-2019)

Purpose Compared to adult AVMs, there is a paucity of data on the microsurgical treatment of pediatric AVMs. We report our institutional experience with pediatric AVMs treated by microsurgical resection with or without endovascular embolization and radiation therapy. Methods We retrospectively reviewed all patients <= 18 years of age with cerebral AVMs that underwent microsurgical resection at Rady Children's Hospital 2002-2019. Results Eighty-nine patients met inclusion criteria. The mean age was 10.3 +/- 5.0 years, and 56% of patients were male. In total, 72 (81%) patients presented with rupture. Patients with unruptured AVMs presented with headache (n = 5, 29.4%), seizure (n = 9, 52.9%), or incidental finding (n = 3, 17.7%). The mean presenting mRS was 2.8 +/- 1.8. AVM location was lobar in 78%, cerebellar/brainstem in 15%, and deep supratentorial in 8%. Spetzler-Martin grade was I in 28%, II in 45%, III in 20%, IV in 6%, and V in 1%. Preoperative embolization was utilized in 38% of patients and more frequently in unruptured than ruptured AVMs (62% vs. 32%, p = 0.022). Radiographic obliteration was achieved in 76/89 (85.4%) patients. Complications occurred in 7 (8%) patients. Annualized rates of delayed rebleeding and recurrence were 1.2% and 0.9%, respectively. The mean follow-up was 2.8 +/- 3.1 years. A good neurological outcome (mRS score <= 2) was obtained in 80.9% of patients at last follow-up and was improved relative to presentation for 75% of patients. Conclusions Our case series demonstrates high rates of radiographic obliteration and relatively low incidence of neurologic complications of treatment or AVM recurrence.