Pediatric arteriovenous malformations

Contrary to their embryological origin, cerebral arteriovenous malformations have traditionally been regarded as an adult disease. Among various types of congenital vascular disease, classified based on their histopathologic features, “true” arteriovenous malformations (AVM’s) are the most challenging in terms of treatment. Most AVMs present in adulthood, with a mean age of patients at presentation of approximately 30-40 years. Nevertheless, the previously reported incidence rates in population based studies are increasing most probably due to detection of asymptomatic cases. Especially availability and extensive utilization of the non-invasive, highly diagnostic magnetic resonance (MR) imaging almost as a screening test enabled to detect AVMs far before they become symptomatic. This is especially true for the pediatric cases; while in previously reported series consisting of mostly symptomatic cases less than 10% would be children, this percentage is almost doubled in more recent reports [1, 2]. Added the difficulties of treating immature child brain with diverse physiology and metabolism, increasing number of asymptomatic AVMs brings more challenge to decision making for treatment. Nevertheless, spontaneous intracerebral hemorrhage is far more common as the initial sign in pediatric population associated with higher morbidity and mortality [1]. This chapter focuses on unique properties of pediatric AVMs contributing the treatment of choice with various modalities.