Considerations For Pediatric Ateriovenous Malformations

Pediatric arteriovenous malformations (AVMs) differ significantly from those that present in the adult population. Children more frequently present with intracranial hemorrhage, though it is controversial whether there is an increased rate of rupture in these patients. Pediatric AVM patients are faced with a high cumulative lifetime morbidity and, due to plasticity of the still-developing brain, appear to tolerate invasive therapy to a greater degree than adults. Patient- and lesion-specific factors necessitate a multidisciplinary approach to treatment, including surgical resection, radiosurgery, and/or embolization. Surgical resection provides the highest rate of obliteration and is considered the definitive treatment when AVM size, location, and morphology are amenable. The appearance of recurrent AVMs after complete obliteration has been documented in children. The nature of these recurrences is not known, but the risks conferred by them lead many clinicians to perform radiographic follow-up for a longer period of time than in adult patients.