Linear vein–based arteriovenous malformations in children

Clinical article

View More View Less
  • 1 Department of Neurosurgery, University of Michigan, Ann Arbor, Michigan; and
  • | 2 Department of Neurosurgery, Children's Hospital Boston, and Harvard Medical School, Boston, Massachusetts
Restricted access

Purchase Now

USD  $45.00

JNS + Pediatrics - 1 year subscription bundle (Individuals Only)

USD  $515.00

JNS + Pediatrics + Spine - 1 year subscription bundle (Individuals Only)

USD  $612.00
Print or Print + Online

Object

The authors reviewed the experience of a single surgeon in the surgical treatment of arteriovenous malformations (AVMs) in children, with specific attention to the angioarchitectural appearance of these lesions.

Methods

The authors performed a retrospective review of pediatric cases of AVM treated at a single institution over a 15-year period. Inclusion criteria consisted of pediatric age at time of treatment and resection of a pial AVM. The AVMs were considered linear-based if they had a single, centrally located, dominant vein with a linear configuration rather than the typical central nidus.

Results

Sixty-seven patients, ranging in age from 6 months to 17 years, underwent surgical treatment of an AVM between January 1, 1990, and December 30, 2005. In these patients, 31 AVMs (46%) had a distinct linear configuration that was centered on a dominant draining vein (“vein-based”). These AVMs presented with hemorrhage (61%), incidental findings on imaging (16%), or seizures (13%). In 4 cases, AVM recurrence was noted on angiographic follow-up after postoperative angiography showed no residual lesion. Recurrence was seen at 1 year in 2 cases, and at 3 and 11 years in 1 case each.

Conclusions

A linear vein–based morphological pattern is common in pediatric AVMs and may recapitulate the embryological origins of the cerebral circulation. Surgical treatment in these cases can also be vein-based, through a narrow surgical corridor, which leads to minimal cortical disruption.

Abbreviations used in this paper:

AVF = arteriovenous fistula; AVM = arteriovenous malformation.

JNS + Pediatrics - 1 year subscription bundle (Individuals Only)

USD  $515.00

JNS + Pediatrics + Spine - 1 year subscription bundle (Individuals Only)

USD  $612.00
  • 1

    Ali MJ, , Bendok BR, , Rosenblatt S, , Rose JE, , Getch CC, & Batjer HH: Recurrence of pediatric cerebral arteriovenous malformations after angiographically documented resection. Pediatr Neurosurg 39:3238, 2003

    • Search Google Scholar
    • Export Citation
  • 2

    al-Rodhan NR, , Sundt TM Jr, , Piepgras DG, , Nichols DA, , Rufenacht D, & Stevens LN: Occlusive hyperemia: a theory for the hemodynamic complications following resection of intracerebral arteriovenous malformations. J Neurosurg 78:167175, 1993

    • Search Google Scholar
    • Export Citation
  • 3

    Andaluz N, , Myseros JS, , Sathi S, , Crone KR, & Tew JM Jr: Recurrence of cerebral arteriovenous malformations in children: report of two cases and review of the literature. Surg Neurol 62:324331, 2004

    • Search Google Scholar
    • Export Citation
  • 4

    Bristol RE, , Albuquerque FC, , Spetzler RF, , Rekate HL, , McDougall CG, & Zabramski JM: Surgical management of arteriovenous malformations in children. J Neurosurg 105:8893, 2006

    • Search Google Scholar
    • Export Citation
  • 5

    Dandy WE: Venous abnormalities and angiomas of the brain. Arch Surg 17:715793, 1928

  • 6

    Forster DM, , Steiner L, & Hakanson S: Arteriovenous malformations of the brain. A long-term clinical study. J Neurosurg 37:562570, 1972

  • 7

    Gonzalez LF, , Bristol RE, , Porter RW, & Spetzler RF: De novo presentation of an arteriovenous malformation. Case report and review of the literature. J Neurosurg 102:726729, 2005

    • Search Google Scholar
    • Export Citation
  • 8

    Higuchi M, , Bitoh S, , Hasegawa H, , Obashi J, & Hiraga S: [Marked growth of arteriovenous malformation 19 years after resection: case report.]. No Shinkei Geka 19:7578, 1991. (Jpn)

    • Search Google Scholar
    • Export Citation
  • 9

    Hladky JP, , Lejeune JP, , Blond S, , Pruvo JP, & Dhellemmes P: Cerebral arteriovenous malformations in children: report on 62 cases. Childs Nerv Syst 10:328333, 1994

    • Search Google Scholar
    • Export Citation
  • 10

    Hoh BL, , Ogilvy CS, , Butler WE, , Loeffler JS, , Putman CM, & Chapman PH: Multimodality treatment of nongalenic arteriovenous malformations in pediatric patients. Neurosurgery 47:346358, 2000

    • Search Google Scholar
    • Export Citation
  • 11

    Houser OW, , Campbell JK, , Campbell RJ, & Sundt TM Jr: Arteriovenous malformation affecting the transverse dural venous sinus—an acquired lesion. Mayo Clin Proc 54:651661, 1979

    • Search Google Scholar
    • Export Citation
  • 12

    Humphreys RP, , Hoffman HJ, , Drake JM, & Rutka JT: Choices in the 1990s for the management of pediatric cerebral arteriovenous malformations. Pediatr Neurosurg 25:277285, 1996

    • Search Google Scholar
    • Export Citation
  • 13

    Kiris T, , Sencer A, , Sahinbas M, , Sencer S, , Imer M, & Izgi N: Surgical results in pediatric Spetzler-Martin grades I–III intracranial arteriovenous malformations. Childs Nerv Syst 21:6976, 2005

    • Search Google Scholar
    • Export Citation
  • 14

    Klimo P Jr, , Rao G, & Brockmeyer D: Pediatric arteriovenous malformations: a 15-year experience with an emphasis on residual and recurrent lesions. Childs Nerv Syst 23:3137, 2007

    • Search Google Scholar
    • Export Citation
  • 15

    Kondziolka D, , Humphreys RP, , Hoffman HJ, , Hendrick EB, & Drake JM: Arteriovenous malformations of the brain in children: a forty year experience. Can J Neurol Sci 19:4045, 1992

    • Search Google Scholar
    • Export Citation
  • 16

    Labropoulos N, , Bhatti A, , Leon L, , Borge M, , Rodriguez H, & Kalman P: Neovascularization after great saphenous vein ablation. Eur J Vasc Endovasc Surg 31:219222, 2006

    • Search Google Scholar
    • Export Citation
  • 17

    Labropoulos N, , Bhatti AF, , Amaral S, , Leon L, , Borge M, & Rodriguez H, et al.: Neovascularization in acute venous thrombosis. J Vasc Surg 42:515518, 2005

    • Search Google Scholar
    • Export Citation
  • 18

    Matson DD, & Ingraham FD: Neurosurgery of Infancy and Childhood ed 2 Springfield, IL, Thomas, 1969. 749

  • 19

    Minakawa T, , Tanaka R, , Koike T, , Takeuchi S, & Sasaki O: Angiographic follow-up study of cerebral arteriovenous malformations with reference to their enlargement and regression. Neurosurgery 24:6874, 1989

    • Search Google Scholar
    • Export Citation
  • 20

    Mullan S: Reflections upon the nature and management of intracranial and intraspinal vascular malformations and fistulae. J Neurosurg 80:606616, 1994

    • Search Google Scholar
    • Export Citation
  • 21

    Mullan S, , Mojtahedi S, , Johnson DL, & Macdonald RL: Cerebral venous malformation–arteriovenous malformation transition forms. J Neurosurg 85:913, 1996

    • Search Google Scholar
    • Export Citation
  • 22

    Mullan S, , Mojtahedi S, , Johnson DL, & MacDonald RL: Embryological basis of some aspects of cerebral vascular fistulas and malformations. J Neurosurg 85:18, 1996

    • Search Google Scholar
    • Export Citation
  • 23

    O'Shaughnessy BA, , DiPatri AJ Jr, , Parkinson RJ, & Batjer HH: Development of a de novo cerebral arteriovenous malformation in a child with sickle cell disease and moyamoya arteriopathy. Case report. J Neurosurg 102:238243, 2005

    • Search Google Scholar
    • Export Citation
  • 24

    Padget DH: The cranial venous system in man in reference to development, adult configuration, and relation to the arteries. Am J Anat 98:307355, 1956

    • Search Google Scholar
    • Export Citation
  • 25

    Padget DH: The development of the cranial venous system in man, from the viewpoint of comparative anatomy. Contrib Embryol 36:79140, 1957

    • Search Google Scholar
    • Export Citation
  • 26

    Perret G, & Nishioka H: Report on the cooperative study of intracranial aneurysms and subarachnoid hemorrhage. Section VI. Arteriovenous malformations. An analysis of 545 cases of cranio-cerebral arteriovenous malformations and fistulae reported to the cooperative study. J Neurosurg 25:467490, 1966

    • Search Google Scholar
    • Export Citation
  • 27

    Rodesch G, , Malherbe V, , Alvarez H, , Zerah M, , Devictor D, & Lasjaunias P: Nongalenic cerebral arteriovenous malformations in neonates and infants. Review of 26 consecutive cases (1982–1992). Childs Nerv Syst 11:231241, 1995

    • Search Google Scholar
    • Export Citation
  • 28

    Sanchez-Mejia RO, , Chennupati SK, , Gupta N, , Fullerton H, , Young WL, & Lawton MT: Superior outcomes in children compared with adults after microsurgical resection of brain arteriovenous malformations. J Neurosurg 105:8287, 2006

    • Search Google Scholar
    • Export Citation
  • 29

    Schmit BP, , Burrows PE, , Kuban K, , Goumnerova L, & Scott RM: Acquired cerebral arteriovenous malformation in a child with moyamoya disease. Case report. J Neurosurg 84:677680, 1996

    • Search Google Scholar
    • Export Citation
  • 30

    Spetzler RF, & Martin NA: A proposed grading system for arteriovenous malformations. J Neurosurg 65:476483, 1986

  • 31

    Stapf C, , Khaw AV, , Sciacca RR, , Hofmeister C, , Schumacher HC, & Pile-Spellman J, et al.: Effect of age on clinical and morphological characteristics in patients with brain arteriovenous malformation. Stroke 34:26642669, 2003

    • Search Google Scholar
    • Export Citation
  • 32

    Stapf C, , Mast H, , Sciacca RR, , Berenstein A, , Nelson PK, & Gobin YP, et al.: The New York Islands AVM Study: design, study progress, and initial results. Stroke 34:e29e33, 2003

    • Search Google Scholar
    • Export Citation
  • 33

    Stein BM, & Wolpert SM: Arteriovenous malformations of the brain I: current concepts and treatment. Arch Neurol 37:15, 1980

  • 34

    Vidyasagar C: Persistent embryonic veins in arteriovenous malformations of the brain. Acta Neurochir (Wien) 40:103116, 1978

  • 35

    Yaşargil MG: Pathological considerations. Microneurosurgery Vol IIIA:New York, Thieme, 1987. 49211

Metrics

All Time Past Year Past 30 Days
Abstract Views 393 120 4
Full Text Views 70 3 0
PDF Downloads 104 2 0
EPUB Downloads 0 0 0