Superior outcomes in children compared with adults after microsurgical resection of brain arteriovenous malformations
- 1 August 2006
- journal article
- research article
- Published by Journal of Neurosurgery Publishing Group (JNSPG) in Journal of Neurosurgery: Pediatrics
- Vol. 105 (2), 82-87
- https://doi.org/10.3171/ped.2006.105.2.82
Abstract
Young age is considered an important factor in determining outcomes after microsurgical resection of arteriovenous malformations (AVMs), but better results in children have not been adequately explained. A consecutive series of pediatric and adult patients was reviewed to determine whether differences in outcomes between these two groups were due to differences in AVM anatomy, rupture rates, neurological condition at presentation, treatment techniques, or other causes. As assessed using the modified Rankin Scale (mRS), patient characteristics, clinical presentation, AVM anatomy, treatment techniques, and outcomes were compared between age groups. Thirty-two pediatric and 192 adult patients underwent microsurgical AVM resection during a 6.4-year period; complete resection was achieved in 97% of the children and 98% of adults. Superior outcomes were observed in children, who had better final mRS scores (p = 0.003) and more favorable changes in these scores (the condition of 94% of children improved or remained unchanged, compared with 70% of adults; p = 0.001). The change in the mean mRS scores was 1.31 for children and 0.14 for adults (p = 0.001). There were no significant clinical, anatomical, or therapeutic differences between children and adults. This analysis confirms the observation that children fare better than adults after microsurgical AVM resection. This discrepancy cannot be explained by differences in AVM anatomy, lesion rupture rates, presenting neurological condition, or treatment techniques, leading the authors to infer that neural plasticity may augment surgical tolerance and recovery in children. These findings bolster the choice of aggressive microsurgical management of AVMs and recalibration of surgical risk assessment in children.Keywords
This publication has 12 references indexed in Scilit:
- Interobserver Variability in Grading of Brain Arteriovenous Malformations Using the Spetzler-Martin SystemNeurosurgery, 2005
- Effect of Presenting Hemorrhage on Outcome after Microsurgical Resection of Brain Arteriovenous MalformationsNeurosurgery, 2005
- A Matched Lesion Analysis of Childhood Versus Adult-Onset Brain Injury Due to Unilateral StrokeCognitive and Behavioral Neurology, 2005
- A Population-Based Comparison of Clinical and Outcome Characteristics of Young Children With Serious Inflicted and Noninflicted Traumatic Brain InjuryPediatrics, 2004
- Gender and age effects on outcome after pediatric traumatic brain injury*Pediatric Critical Care Medicine, 2004
- Spetzler-Martin Grade III Arteriovenous Malformations: Surgical Results and a Modification of the Grading ScaleNeurosurgery, 2003
- Interobserver agreement for the assessment of handicap in stroke patients.Stroke, 1988
- A proposed grading system for arteriovenous malformationsJournal of Neurosurgery, 1986
- Cerebral arteriovenous malformations in children clinical features and outcome of treatment in children and in adultsSurgical Neurology, 1984
- THE ROLE OF EARLY LEFT‐BRAIN INJURY IN DETERMINING LATERALIZATION OF CEREBRAL SPEECH FUNCTIONSAnnals of the New York Academy of Sciences, 1977