Pediatric brain AVMs present challenges
Not all AVMs may be surgical candidates.
Brain arteriovenous malformation (AVM) can be tough enough to treat in adults. When the condition is present in children, it can have even more challenges, said two scientists who will lead a panel of experts in a Wednesday session.
The main challenge with pediatric AVM is the size and location, according to Shih-Shan Chen, MD, attending neurosurgeon in the Division of Neurosurgery and director of vascular neurosurgery and associate director with the trauma center at Children’s Hospital of Philadelphia.
“Many pediatric AVMs are quite large or holo-hemispheric or deep in the thalamus/basal ganglia, making it not a surgical candidate,” Dr. Chen said. “There can also be a lot of potential neurological deficits with radiation.”
Steven Hetts, MD, co-chief of the Neuroendovascular Surgery Service Line, chief of interventional neuroradiology for Mission Bay Hospitals and professor of radiology, biomedical imaging and neurological surgery at the University of California, San Francisco, said there can be post-surgery challenges as well.
“Ruptured pediatric AVMs appear to have a higher recurrence rate after resection, thus requiring longer-term surveillance than for adult patients,” he said. “We have needed to retreat several patients over the years despite apparent initial cures. This seems to be less of an issue for ruptured AVMs.”
Drs. Chen and Hetts will discuss these and other challenges and their potential solutions in Wednesday’s session, From Bench to Beside and Beyond | Pediatric Brain AVMs: From a Bedside Problem to Bench-Based Solutions.
Another challenge in dealing with pediatric AVMs is transitioning patients to adulthood, Dr. Chen said. However, she said it isn’t quite as challenging as other pediatric neurosurgery disorders.
“A lot of adult providers already see children with AVMs, meaning vascular surgeons often do both at most major academic centers,” she said. “The challenge comes with treatment options, as a lot of options (such as radiation) are not possible with really young kids.”
One area of research aimed at helping treat pediatric AVMs uses animal models of brain AVMs to find certain biomarkers that can hopefully translate into human brains.
“The major issues with AVMs are recurrence in pediatrics — which is much more problematic than in adults — and the need to have an invasive test to figure out if the AVM has occurred,” Dr. Chen said. “There are studies that show the more compact the nidus of the AVM, the less likely it is to recur. Biomarkers that could non-invasively detect the recurrence of AVMs would be ideal.”
Disorders such as hereditary hemorrhagic telangiectasia (HHT) are still unknown in the development of when and how AVMs occur if you have this genetic mutation, Dr. Hetts said. “Animal models in these disorders would be helpful in knowing when to surveil and knowing the natural history of these particular AVMs.”
This is the first of this year’s Bench to Bedside sessions. Be sure to also check out Thursday’s session, From Bench to Bedside and Beyond: Cerebral Microcirculation and Neurovascular Coupling.