Hoh B L, Ogilvy C S, Butler W E, Loeffler J S, Putman C M, Chapman P H
Neurosurgical Service, Massachusetts General Hospital, Boston 02114, USA.
Neurosurgery. 2000 Aug;47(2):346-57; discussion 357-8. doi: 10.1097/00006123-200008000-00015.
Previously reported series of arteriovenous malformations (AVMs) in pediatric patients have primarily used a single-modality treatment approach of either surgery, radiosurgery, or embolization, with significant treatment-related morbidity and mortality. At our institution, we have used a combined multidisciplinary team approach of all three treatment modalities, alone or in combination, to minimize complications and to maximize efficacy in the management of these lesions.
We retrospectively reviewed 40 consecutive pediatric patients with AVMs seen at our institution from 1991 to 1999. A multidisciplinary team planned the treatment for each AVM. The treatment modality consisted of the following approaches: surgery alone in 14 patients, a combination of endovascular embolization and surgery in 6 patients, radiosurgery alone in 11 patients, a combination of endovascular embolization and radiosurgery in 2 patients, and a combination of radiosurgery and surgery in 2 patients. Four patients are receiving ongoing multistaged treatment for reduction of the nidus size for eventual surgical resection or radiosurgical obliteration of large, complex lesions. In one patient, no treatment was recommended.
The clinical outcomes for the overall series were 95.0% excellent or good (Glasgow Outcome Scale score 5 or 4), 2.5% fair (Glasgow Outcome Scale score 3), and 2.5% dead. Radiographic efficacy in the patients who have completed treatment was 92.9% complete obliteration of their AVMs and 7.1% incomplete obliteration. Of the 10 patients who had seizures, 9 are seizure-free.
A combined multimodality approach of surgery, radiosurgery, and embolization in managing AVMs in pediatric patients can improve outcomes and minimize morbidity and mortality.
先前报道的小儿患者动静脉畸形（AVM）系列研究主要采用单一治疗方式，即手术、放射外科或栓塞治疗，这些治疗方式均伴有显著的与治疗相关的发病率和死亡率。在我们机构，我们采用了由所有三种治疗方式单独或联合组成的多学科团队综合治疗方法，以尽量减少并发症并在这些病变的管理中最大化疗效。
我们回顾性分析了1991年至1999年在我们机构连续就诊的40例小儿AVM患者。一个多学科团队为每个AVM制定治疗方案。治疗方式包括以下几种：14例患者仅接受手术治疗，6例患者接受血管内栓塞和手术联合治疗，11例患者仅接受放射外科治疗，2例患者接受血管内栓塞和放射外科联合治疗，2例患者接受放射外科和手术联合治疗。4例患者正在接受多阶段治疗，以缩小病灶大小，最终对大型复杂病变进行手术切除或放射外科闭塞。1例患者未建议进行治疗。
整个系列的临床结果为95.0%为优或良（格拉斯哥预后评分5或4），2.5%为中等（格拉斯哥预后评分3），2.5%死亡。完成治疗的患者中，影像学疗效为92.9%的AVM完全闭塞，7.1%不完全闭塞。10例有癫痫发作的患者中，9例无癫痫发作。
手术、放射外科和栓塞联合的多模式方法治疗小儿AVM可改善预后并尽量减少发病率和死亡率。
