2019 Volume 24 Issue 1 Pages 87-94
Pediatric arteriovenous malformations (AVMs) account for approx. 18%‒20% of all AVMs. Compared to adults, the incidence of bleeding in children with an AVM is high, and rebleeding tends to occur. Surgical removal is thus considered effective as the initial treatment in pediatric AVM cases. We report the cases of three pediatric AVM patients successfully treated by surgical removal after transarterial embolization (TAE). Case 1: A 13‒year‒old male developed an intracranial hematoma in the right occipital lobe and was diagnosed with an AVM (Spetzler‒Martin grade [SMG]: 2) in that lobe. TAE was performed using general anesthesia, followed by complete surgical removal. Case 2: A 9‒year‒old male developed an intracranial hematoma in the right occipital lobe and was diagnosed with an AVM (SMG: 2) in that lobe. TAE was performed using general anesthesia, followed by complete surgical removal. Case 3: A 13‒year‒old female in a state of cardiopulmonary arrest was transported by ambulance. Computed tomography (CT) after resuscitation showed cerebellar and intraventricular hemorrhages, and emergency removal of the hematoma was performed. Based on the results of the subsequent close examination, a diagnosis of a cerebellar AVM (SMG: 4) was made. TAE was performed using general anesthesia, followed by complete surgical removal. In each patient, bleeding during the operation was well controlled, confirming the effectiveness of TAE. In pediatric AVM patients, considering the risk of rebleeding affecting the long‒term prognosis and the plasticity of children’s brain tissue, total resection should be performed whenever possible for the prevention of rebleeding. Surgical resection on the day of embolization is recommended because anesthesia is administered only once.
