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What is the best therapeutic approach to a pediatric patient with a deep-seated brain AVM? A systematic review
EANS Academy. Patet G. Sep 27, 2019; 275934; EP01096
Abstract
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Background: Pediatric brain AVMs tend to rupture more frequently and have higher recurrence rates than adults. In order to identify the best approach to deep-seated pediatric AVMs, we performed a systematic review, according to the PRISMA guidelines.
Materials and methods: PubMed search from 2008 to 2018 using: 'cerebral' [All Fields] AND 'children' [All Fields] OR 'pediatric' [All Fields] AND ('arteriovenous malformations' [MeSH Terms] was performed.
Results: Of the 261 articles identified, 245 were excluded due to the AVM not being deep-seated, not being in English, or not giving information about the type of treatment and the outcomes. Finally, 16 articles were analyzed with respect to treatment modalities, study design, number of patients, obliteration rates, time from treatment to obliteration, and complications.
Discussion: The treatment options identified were conservative, microsurgery (MS), endovascular (EVT), gammaknife (GKRS), proton-beam (PBRS), or a combination of the above. None of the options seem to offer a clear advantage when used alone. MS provides the highest obliteration rate, but has higher incidence of neurological complications. EVT as a stand-alone therapy has low cure rates, and there is a high risk of partial embolization. GKRS has a low risk profile, but the obliteration rates still leave much to be desired. PBRS offers promising results, but data is limited due to its recent introduction. Lastly, the long-term side-effects of radiation are still unknown.
Conclusions: A multi-modal approach, or even an active surveillance, might be the most suitable for many deep-seated pediatric AVMs, considering the difficulty of their management and the high risk of complications.
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