INTRACRANIAL ARTERIOVENOUS-MALFORMATIONS IN CHILDHOOD - PRESENTATION,MANAGEMENT AND OUTCOME

Cases of true intracranial arteriovenous malformations (AVMs) presenti ng over a 25 year period were reviewed in order to achieve a better un derstanding of the behaviour and management of AVMs in children, There were 69 cases, presenting with haemorrhage (78%), seizures (13%) card iac failure (3%) and focal signs with or without headache (6%), It was less common to present under six years of age, CT scanning, where per formed, always demonstrated an abnormality, but this was suggestive of an AVM in less than one third. By contrast, angiography defined the l esion in 82% of initial studies, 59 patients underwent a surgical proc edure directed at their AVM or an associated haematoma, Total AVM exci sion was obtained in 65%, with none of these later rebleeding, Three p atients presenting solely with seizures were not operated upon initial ly but underwent successful resections of their lesions after later ha emorrhages, There were 6 (9%) deaths in the series, with focal deficit s in 52% of survivors at last follow up, In the operative group these figures were 3% and 51%, respectively, None of the eight patients oper ated upon prior to a clinical bleed suffered a new neurological defici t, The role of stereotactic radiosurgery, although not used in any of our cases, is discussed. We believe that our results support an aggres sive surgical approach to childhood AVMs, regardless of presentation, given the significant risk of morbidity from a later bleed, and the la ck of a clearly better outcome with expectant management or irradiatio n. (C) Pearson Professional 1996