What are the treatment options for a brain AVM in children?

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Dr. Geoffrey P. Colby, MD
Neurosurgery
Treatment options for arteriovenous malformations (AVMs) in the brain in children where an AVM has caused a hemorrhage are the same as for adults.

What's unique about children is, first, there is a very long period of time (their natural life span) ahead of them, a long period of time during which they are at risk of having a brain hemorrhage. Doctors are therefore more direct about trying to treat AVMs in children, to protect them for their future and making sure of the quality of their future potential life.

Secondly, children often have relatively diffuse AVM blood vessels that have not coalesced into a compact nidus (core), and that influences how the surgery is done and influences how radiation therapy is done. Finally, children are very resilient. They get through surgery with fewer complications and problems than adults do, and if there are any neurological problems related to hemorrhage from the AVM or the treatment itself, children have a greater capacity for brain recovery and recovery of function than adults do. This is called plasticity or recoverability of the brain.
Rafael Alexander Ortiz
Neurosurgery

Arteriovenous malformations (AVMs) of the brain are abnormal connections between arteries and veins of the brain. AVMs of the brain are either congenital, or form in the very early stage of life. The risk of a brain AVM is rupture presenting with bleeding in the head, seizures, and headaches. These malformations, especially in children, can also present with neurological signs and symptoms (like weakness, blindness, lethargy/nausea/vomiting, and developmental delay).

The diagnostic work up for a brain AVM in a child will include assessment by the pediatric neurologist, pediatric neurosurgeon, and pediatric neuro-endovascular surgeon. Neuroimaging work up includes a CT scan of the head and an MRI/A of the brain.

Treatment of an AVM of children at an early age is with endovascular therapies and/or surgery. A femoral cerebral angiogram is necessary for assessment of the brain AVM, and at the same time the angiogram is performed, endovascular treatment with glue and/or Onyx can be performed as a definitive treatment or in preparation for future surgery. In older children (after 8 to 10 years old), radiosurgery is a treatment option as well.