Adjuvant Therapies for Cerebral Arteriovenous Malformations in Children

Medical

• No curative treatments: Currently, no accepted medical treatments for the cure of AVMs in children exist. Medical therapies are focused on the abrogation of symptoms (e.g., headache medication, antiepileptic medication, blood pressure control).

Other

• Embolization as an adjuvant therapy: Staged embolization of the arterial feeders is rarely curative, but it may be useful as an adjuvant therapy prior to microsurgery or radiosurgery (101). The role of embolization is to facilitate surgery, prevent hemorrhage, and reduce nidal volume (21).
• Radiosurgery for lesions smaller than 3 cm: Conventional fractionated radiation is not helpful in treating most AVMs. In contrast, stereotactic radiosurgery offers cure rates of up to 90% for lesions smaller than 3 cm (102,103). This approach is beneficial for surgically inaccessible lesions or for lesions in patients who are high-risk surgical candidates. Shortcomings of this approach include a delay of up to 3 years for lesion obliteration and exposure to radiation in children. Radiation has increased risk in younger populations, making its application less appealing in children younger than 3 years.