E-044 Safety and outcome of combined endovascular and surgical management of low grade cerebral arteriovenous malformations in children compared to surgery alone

Purpose To evaluate the outcomes of combined preoperative embolization and subsequent surgical resection in comparison with the surgical resection as the current standard of care for low-grade cerebral arteriovenous malformations (AVM) in the pediatric population. Materials and Methods The current study represents a retrospective review of pediatric patients with Spetzler-Martin (S-M) grades I and II cerebral AVMs treated between January 2005 and September 2016. Patients were divided into two groups: surgery alone or embolization plus surgical resection of AVM. Outcomes were assessed using the modified Rankin Scale (mRS) before and after the treatment, at 3 months and at final follow up. The association of demographics, clinical presentations, and lesions’ morphological characteristics with the Complications was studied as well. Results A total of 41 patients with low grade cerebral AVMs were identified during the study period. Only 34 patients met the inclusion criteria of this study with a mean age 10.6±3.4 years (Range, 3–16 years). Twenty Two patients were boys and 12 girls. Twenty patients (59%) presented with ruptured AVMs [OR:0.57;95% CI:0.13–2.37; P-value:0.44]. Twenty-five patients underwent combined treatment with pre-operative embolization followed by microsurgical resection (73.5%), while the rest (26.5%) underwent microsurgical resection only A total of 35 embolization procedures were performed for 25 patients (Mode, 1; Range, 1 to 7). The mean follow-up time was 35.7 months. Only 2 minor complications resulted from all the embolization procedures with no clinical sequelae, and No change in mRS Score. There was no significance difference in the overall complication rate between both treatment groups [OR:1.13; 95% CI:0.23–5.62; P-value:0.89]. Three new neurological deficits resulted from the combined treatment; one was transient and the other two complications were non-disabling (mRS ≤2). While in the surgical management group, 2 neurological deficits were observed; one of which was disabling. The final outcome was good (mRS ≤2) in all combined treatment group. There was no Significant difference in the overall favorable outcome (no change or improved mRS score) [OR:0.67; 95% CI: 0.12–3.64; P-value:0.64], favorable outcome in patients who presented with ruptured AVMs vs. non-ruptured [OR:0.57; 95% CI:0.13–2.37; P-value:0.44], or patients with poor mRS score pre-operatively vs. good score [OR:0.57; 95% CI: 0.14–2.38; P-value:0.44]. Grades of cerebral AVM [OR:13.2; 95% CI: 13.199–13.20006; P-value: 0.011] and supratentorial v/s infratentorial [OR: 5.62; 95% CI: 1.10–22.82; P-value:0.05] were independently associated with complications. Conclusion Our results suggest no significant difference in the treatment complications and outcomes between combined endovascular and surgical management of low grade cerebral AVMs in children compared to surgical management alone. Disclosures A. Al-Smadi: None. T. Shokuhfar: None. A. Malani: None. S. Ansari: None. M. Hurley: None. B. Jahromi: None. M. Potts: None. A. Shaibani: None.