Publication year: 2011
Source: World Neurosurgery, Available online 1 November 2011
M. Yashar S. Kalani, Azam Ahmed, Nikolay L. Martirosyan, Katharine Cronk, Karam Moon, ...
BACKGROUNDPediatric spinal arteriovenous malformations (AVMs) are rare and complex lesions to treat. There are few reports of the endovascular and microsurgical treatment of these lesions in the pediatric population, and the treatment outcomes of these patients are not well described.OBJECTIVETo study the clinical and radiographic outcomes of spinal AVMs in pediatric patients treated via endovascular and microsurgical modalities.METHODSWe identified 9 children (5 boys, 4 girls; average age 11 years, range 3-17 years) treated for spinal AVMs between 1998 and 2010. Their charts were reviewed.RESULTSSpinal AVMs most frequently involved the thoracic spinal cord. Four patients had associated Klippel-Trènaunay-Weber (KTW) syndrome and one had hereditary hemorrhagic telangiectasia. There were 2 intramedullary, 4 conus medullaris, and 3 mixed extradural-intradural lesions. The most common presenting signs and symptoms were subarachnoid hemorrhage (SAH, n=3) and paraparesis (n=5). Endovascular intervention was utilized exclusively in 2, and combined endovascular and microsurgical intervention was used in 4 cases. Surgery was the sole treatment in 3 cases with excellent results. There were two treatment-related complications: one case of SAH and one case of scrotal swelling. The mean follow up was 28.5 months and the median 8 months (range 1-65 months). The mean pretreatment WHO/Zubrod score was 2.4 (range 1-4), and the mean posttreatment score was 1.4 (range 0-4). One patient (11%) had a recurrence.CONCLUSIONSPediatric spinal AVMs require complex combined microsurgical and endovascular techniques to achieve favorable outcomes.
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