Silva Adikarige Haritha Dulanka, James Greg
Department of Neurosurgery, Great Ormond Street Hospital for Children, London, UK.
Great Ormond Street Institute of Child Health, University College London, London, UK.
J Korean Neurosurg Soc. 2024 May;67(3):280-288. doi: 10.3340/jkns.2024.0037. Epub 2024 May 1.
Brain arteriovenous malformations (bAVMs) are aberrant arteriovenous shunts through a vascular nidus with no intervening capillary beds. They are one of the commonest causes of spontaneous intracranial haemorrhage in children and may be associated with significant morbidity and mortality in cases of rupture. Treatment strategies include microsurgical resection, endovascular embolisation, stereotactic radiosurgery, multimodality treatment with a combination thereof, and particularly in high-grade bAVMs, conservative management. Clinicians involved in treating bAVMs need to have familiarity with the natural history pertaining to bAVMs in terms of risk of rupture, risk factors elevating rupture risk as well as understanding the clinical manifestations of bAVMs. This invited review serves to provide a synthesis on natural history and clinical presentation of bAVMs with particular focus in children to inform decision-making pertaining to management.
脑动静脉畸形(bAVM)是通过血管巢的异常动静脉分流,其间没有毛细血管床。它们是儿童自发性颅内出血最常见的原因之一,破裂时可能伴有显著的发病率和死亡率。治疗策略包括显微手术切除、血管内栓塞、立体定向放射外科、联合多种方式的多模态治疗,特别是对于高级别bAVM,采用保守治疗。参与治疗bAVM的临床医生需要熟悉bAVM的自然病史,包括破裂风险、增加破裂风险的危险因素以及了解bAVM的临床表现。这篇特邀综述旨在综合bAVM的自然病史和临床表现,特别关注儿童,为管理决策提供参考。