小児期に発症した脳動静脈奇形63例の分析

Abstract

During the years 1974-1988, sixty-three cases of arteriovenous malformation (AVM) in children and adolescents were experienced. Fifty-three patients (84.1%) had hemorrhage (intracerebral hematoma and/or intraventricular hemorrhage), and 2 of them died from the first hemorrhage. Ten patients had nonhemorrhagic symptoms, such as epilepsy and cerebral steal syndrome. Three fourths of the patients with hemorrhagic presentation had small AVMs (less than 2 cm in diameter).Forty cases (63.5%) were treated with surgery and total excision of AVMs could be accomplished in 32 (80.0% of surgical cases). Eight cases had incomplete surgery (feeder clipping or partial resection of the nidus) and 21 cases were followed without surgery. Of these 29 cases, 10 cases (34.5%) experienced later hemorrhages during the mean follow-up period of 6.0 years. There was no difference in incidence and interval of later hemorrhages between cases with hemorrhagic and nonhemorrhagic presentation.Outcome was poor in cases of recurrent hemorrhages and also poor in young patients developing cerebral steal syndrome with large AVM.Optimal management consists of total excision of AVMs. There were, however, approximately 30-40% of patients for whom no surgery was indicated. It is important to recognize the natural history of these non-surgical cases. To improve overall mortality and morbidity of AVMs in children, non-surgical cases should be properly treated by any other means such as radiosurgery or embolization.