Arteriovenous malformations of the brain in children.

A survey of 23 children treated for arteriovenous malformations of the brain is presented. Venous angiomas and aneurysms of the vein of Galen were excluded. Spontaneous hemorrhage was the first symptom in 83%. Angiographically occult arteriovenous malformations were found in 22% of cases. Contrast-enhanced CT failed to opacify abnormal vessels in most of these occult lesions. Fourteen patients underwent complete excision of their malformation with only 1 death (7.1% surgical mortality). Overall mortality for the group was 21.7%. Outcome was related to treatment modality and clinical condition on presentation. Four of 8 patients presenting in deep coma died, but 3 are normal and one slightly disabled. A spontaneous cerebral hemorrhage in a child is probably due to a vascular malformation, even when angiography and enhanced CT are negative. Optimal management consists of complete removal of the malformation; residual lesions tend to rebleed with fatal outcome. With aggressive treatment, complete recovery is possible even for children who present in coma.