Challenges in the management of pediatric ruptured brain arteriovenous malformation: a case report

Celia Celia; Susilawati Susilawati; Johanes Ari Cahyo; Robert Shen; Irene Fenia

doi:10.14238/pi64.1.2024.90-6

Celia Celia Department of Surgery and Atma Jaya Neuroscience Research (ANR), Master Study Program in Biomedical Sciences, School of Medicine and Health Sciences, Universitas Katolik Indonesia Atma Jaya, Jakarta
Susilawati Susilawati Department of Child Health, Atma Jaya Hospital, Jakarta
Johanes Ari Cahyo Department of Child Health, Atma Jaya Hospital, Jakarta
Robert Shen Department of Surgery and Atma Jaya Neuroscience Research (ANR), Master Study Program in Biomedical Sciences, School of Medicine and Health Sciences, Universitas Katolik Indonesia Atma Jaya, Jakarta https://orcid.org/0000-0002-2063-4145
Irene Fenia Atma Jaya Hospital, Jakarta https://orcid.org/0000-0002-8513-7270

DOI: https://doi.org/10.14238/pi64.1.2024.90-6

Keywords: brain arteriovenous malformation (bAVM), open microsurgery, stereostatic radiosurgery (SRS), pediatric intensive care

Abstract

Brain arteriovenous malformations (bAVMs) are intracranial vascular lesions characterized by abnormal connections between the arterial and venous systems without an interposed capillary bed. Pediatric bAVMs constitute merely 12–18% of all diagnosed bAVMs, but an initial finding of bAVM rupture occurs more frequently in the pediatric population than in adults, accounting for 58–77% of all pediatric bAVM admissions.^1,2 Although spontaneous pediatric intracerebral hemorrhage has an annual incidence of 1.4 per 100,000 people per year, it carries a risk of severe permanent neurological deficits, occurring in 20–40% of patients and significant mortality in up to 25% of affected individuals.^3,4,5 Ruptured bAVMs are the cause of 30-50% of intracranial hemorrhages in the pediatric population and the most common cause of hemorrhagic stroke in children.¹ Current therapeutic approaches for ruptured bAVMs in children include open microsurgery, endovascular embolization, as well as stereotactic radiosurgery (SRS), be it isolated or as a multimodal treatment strategy. Herein, we present the case of a 6-year-old boy with a ruptured bAVM successively managed with hemicraniectomy decompression and intracranial bleeding evacuation, followed by stereotactic radiosurgery (SRS) using gamma knife for the small AVM which was inaccessible during open surgery.

Author Biographies

Celia Celia, Department of Surgery and Atma Jaya Neuroscience Research (ANR), Master Study Program in Biomedical Sciences, School of Medicine and Health Sciences, Universitas Katolik Indonesia Atma Jaya, Jakarta

Susilawati Susilawati, Department of Child Health, Atma Jaya Hospital, Jakarta

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