Edward Smith, M.D.
Editor in Chief
AVMs are among the most important vascular anomalies in the nervous system of children; they are relatively common and usually require treatment. They consist of direct arterial-to-venous connections without intervening capillaries and occur in the cerebral hemispheres, brainstem, and spinal cord (1).
AVMs can present with hemorrhage, seizure, headache, or progressive ischemia (“steal”), or they may be found incidentally. Treatment is predicated on obliteration of the lesion, which can be achieved by surgery, radiation, embolization, or a combination of therapies.
- AVMs common: AVMs are the most common symptomatic intracranial vascular abnormality (2). In a large autopsy series, an overall frequency of detection for AVMs was 1.4% (3).
- High mortality rate in children: Hemorrhagic events from an AVM in childhood have been associated with a 25% mortality rate (4).
- CT angiography increasingly used for screening: CT angiography has increasingly been employed as an initial study for children presenting to the emergency department with nontraumatic intracranial hemorrhage, followed by MRI and catheter-based DSA if an AVM is found (5).
- Best treated by a multidisciplinary team: Treatment for pediatric AVMs should be performed at experienced centers with multidisciplinary teams able to offer all modalities of therapy (surgery, embolization, and radiation) whenever possible (52).
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