Nair Anup P, Kumar Raj, Mehrotra Anant, Srivastava A K, Sahu Rabi Narayan, Nair Prakash
Department of Neurosurgery, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow 226014, India.
Childs Nerv Syst. 2012 Apr;28(4):593-8. doi: 10.1007/s00381-011-1668-6. Epub 2012 Jan 21.
Treatment of pediatric arteriovenous malformations (AVMs) is always a challenge considering their hemorrhagic presentation, associated morbidity and mortality, and the potential long life span of these children. Spetzler-Martin grades I-III are the grey zones as far as the treatment options are concerned. With a generous multimodality approach, one can reduce the morbidity and mortality to a considerable extent.
To analyze the demographic and clinico-radiological profile of pediatric intracranial AVMs belonging to Spetzler-Martin grades I-III and their outcome following microsurgical excision.
Pediatric patients (≤18 years of age) from a period of January 2001-January 2011 were included in the study. Patients with associated aneurysms or tumors were excluded from the study. Post-operative DSA/CT angiography was done within 6 weeks after surgery. Outcome was analyzed in terms of neurological improvement according to Medical Research Council Grade (MRC), obliteration of the AVM in post-operative angiography and Modified Rankin score. Outcome based on Modified Rankin score was favorable with a score of 0-2 and unfavorable when the score was 3-6.
A total of 36 patients with a mean follow-up of 12.75 months were identified. Thirty-one patients (86.1%) presented with hemorrhage while only 15 (41.6%) presented with seizures. There were 25 (69.4%) males and 11 (30.6%) females. Spetzler-Martin grade was grade I in six patients, grade II in 20 patients, and grade III in ten patients. All patients underwent surgical excision of the AVMs and post-operative angiography showed a 100% obliteration rate. There was a favorable outcome in 86.1% of the patients according to modified Rankin score.
The aim of treating a pediatric AVM should be complete obliteration of the AVM considering the high risk of hemorrhage and the morbidity and mortality associated with hemorrhage. With careful planning and adopting a multimodality treatment, complete obliteration can definitely be achieved.
考虑到小儿动静脉畸形（AVM）的出血表现、相关的发病率和死亡率以及这些儿童可能较长的寿命，其治疗一直是一项挑战。就治疗选择而言，Spetzler-Martin I-III级属于灰色地带。采用综合多模式方法，可在很大程度上降低发病率和死亡率。
分析Spetzler-Martin I-III级小儿颅内AVM的人口统计学和临床放射学特征，以及显微手术切除后的结果。
纳入2001年1月至2011年1月期间的小儿患者（≤18岁）。伴有动脉瘤或肿瘤的患者被排除在研究之外。术后6周内进行术后DSA/CT血管造影。根据医学研究委员会分级（MRC）的神经功能改善情况、术后血管造影中AVM的闭塞情况和改良Rankin评分来分析结果。基于改良Rankin评分的结果，评分为0-2时为良好，评分为3-6时为不良。
共确定36例患者，平均随访12.75个月。31例患者（86.1%）有出血表现，而仅有15例（41.6%）有癫痫发作。男性25例（69.4%），女性11例（30.6%）。Spetzler-Martin分级中，I级6例，II级20例，III级10例。所有患者均接受了AVM的手术切除，术后血管造影显示闭塞率为100%。根据改良Rankin评分，86.1%的患者预后良好。
考虑到出血的高风险以及与出血相关的发病率和死亡率，治疗小儿AVM的目标应是完全闭塞AVM。通过精心规划并采用多模式治疗，肯定可以实现完全闭塞。
