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ORIGINAL ARTICLE
Year : 2020  |  Volume : 33  |  Issue : 4  |  Page : 1405-1409

Endovascular management of ruptured cerebral arteriovenous malformations in pediatric patients


1 Department of Neurosurgery, Faculty of Medicine, Menoufia University, Menoufia, Egypt
2 Department of Neurosurgery, Faculty of Medicine, Tanta University, Tanta, Egypt

Correspondence Address:
Mohamed S.M. Elsanafiry
21 Alnozha Street, Birket Elsaba, Menoufia
Egypt
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/mmj.mmj_112_20

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Objective To evaluate the efficacy, safety, and outcome of endovascular therapy (EVT) of ruptured cerebral arteriovenous malformation (c-AVM) in pediatric patients. Background Children with c-AVM have a higher annual risk of hemorrhage than adults (2–4 vs. 1–3% per year). Hemorrhage is fatal in ~25% of these children. Complete obliteration is most commonly achieved by multimodal therapy, which includes microsurgery, EVT, and stereotactic radiosurgery or a combination of two or more of these techniques. Patients and methods A prospective study included 18 patients (eight male and 10 female), with a mean age of 10.7 years (4–17 years). All had supratentorial c-AVMs, and none had a family history. According to the Spetzler–Martin grading system, two patients had grade I AVMs, six patients had grade II AVMs, eight patients had grade III AVMs, and two patients had grade IV AVMs. EVT was selected as the primary modality of treatment. Results A total of 10 patients had complete obliteration of the nidus, four patients had near-total obliteration, and four patients had incomplete obliteration requiring further treatment. After EVT, 10 patients had grade 0 in the Modified Rankin Scale, four patients had grade I, two patients had grade II, one patient had grade III, and one patient had grade IV. Conclusion In this article, EVT was an effective and safe technique for the treatment of c-AVMs showing a high cure rate as a single treatment modality or as a preprocedural technique facilitating other forms of treatment and improving the outcome of the cases.


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