Management of Cerebral Arteriovenous Malformations in Children

Initial Management at Presentation

• Initial management predicated on presentation: If the child presents with a hemorrhage or is acutely symptomatic, urgent intervention is often warranted. If the child has an AVM found incidentally, evaluation can proceed in a nonemergent fashion, with concomitant discussion about treatment options with the family. See Presentation
• Decision based on risk/benefit analysis: Although no definitive guidelines exist, there is general consensus that obliteration of cerebral AVMs in children is justified if the risk of treatment is considered less than the risk of hemorrhage. Surgery is often cited as a first-line treatment, although growing experiences with radiosurgery and, to a lesser extent, embolization, are increasing the breadth of treatment options.

Adjunctive Therapies

• Embolization: Surgery and radiosurgery are generally considered primary treatments for AVM. Embolization can be a useful adjunct for enhancing the efficacy of these two treatments, but embolization as a stand-alone treatment for AVM remains controversial.

Follow-up

• Annual: Postoperative care frequently consists of an office visit about 1 month postoperatively, then annually thereafter. MRI accompanies these visits for the first 5 years, and angiography is considered at 1 year after treatment.