1168. Outcomes of Multimodal Management for Intracranial Pediatric Arteriovenous Malformations

Authors: Mark Gregory Bigder, MD, FAANS; Ephraim Church, MD; Arjun Pendharkar, MD, MS; Eric Sussman, MD; Steven Chang, MD; Huy Do, MD; Robert Dodd, MD, PhD; Gerald Grant, MD; Jeremy Heit, MD, PhD; Michael Marks, MD; Gary Steinberg, MD, PhD (Thunder Bay, Canada)

Introduction: Successful surgical treatment of pediatric arteriovenous malformations often requires a multidisciplinary approach to optimize surgical resection while minimizing patient risk. Methods: We retrospectively reviewed and analyzed records of all pediatric patients (<18yo) treated for an intracranial arteriovenous malformation at our institution from July 1992 to October 2018 and selected patients who underwent surgical resection primarily, or in combination with endovascular therapy and/or stereotactic radiosurgery as the focus of this study. Results: There were 219 pediatric patients treated for intracranial AVM, 85 of which underwent surgical resection either primarily, or in combination with endovascular therapy and/or stereotactic radiosurgery. Seventy-one patients had sufficient data for analysis of which 57 (80%) had a low Spetzler-Martin (SM 1-3) grade lesion while 14 (20%) had a high SM (4-5) grade lesion. Hemorrhage was the inciting event for presentation in 23 patients (32%), seizure in 9 (13%), headache (in the absence of hemorrhage) in 8 (11%), progressive neurological deficits in 4 (6%), while 8 (11%) AVMs were discovered incidentally. Seventeen patients (24%) underwent solely surgical resection while 56 (79%) underwent a combination of surgery, endovascular therapy and/or stereotactic radiosurgery. The mean number of procedures per patient was 3.1 (range: 1-17). Overall obliteration rate was 73% (52/71) among all patients, 75% (43/57) among low SM grade lesions and 64% (9/14) for high SM grade patients. Conclusion: Management of pediatric AVMs, particularly high-grade lesions, remains a formidable challenge despite the adjuvant use of endovascular therapy and stereotactic radiosurgery to complement surgical resection. Careful consideration of the risks and outcomes associated with treatment of pediatric AVMs must be weighed against the natural history of this disease.