The records of 39 patients with arteriovenous malformations (AVM) treated at the University of Utah during a 15-year period (1989-2004) were reviewed and analyzed for presentation, location, Spetzler-Martin grade (size, eloquence of adjacent brain, and superficial or deep venous drainage), obliteration rate following surgery, and recurrence rate. Twenty five were girls and 14 boys. Their average age was 10.3 years (range 1 month to 16 years), and average follow-up was 30 months. Spontaneous intracerebral hemorrhage (ICH) was the most common presentation (n=22, 57%), followed by new-onset seizures (15%) and headaches (10%); the remaining 7 cases were discovered incidentally. The location of the AVM was parietal lobe in 14 (36%), cerebellum (18%), frontal lobe (15%), occipital lobe (10%), and thalamus (8%). AVM was compact in 32 (82%), and diffirse in 18%. Primary treatment was microsurgical resection in 35 (90%). Obliteration rate was 89%. Nine (23%) had a residual nidus, of which 4 had a diffuse AVM. Five (13%) developed a recurrent AVM, of which 4 were diffuse-type AVM; 3 resolved after repeat surgery. The mean latency between an apparent cure and recurrence was 43 months (range, 6 months to 6 years). Preoperative embolization was used as an adjunct to surgery in 18 (46%) patients, and stereotactic radiosurgery for inoperable AVMs in 2 and recurrences in 1 patient. [1]

COMMENT. A similar review and retrospective analysis of 62 children with AVM treated at the Hospital B, Lille, France, showed that intracranial hemorrhage and stroke were the presenting manifestations in 54 (87%); 7 had a history of headache, and 5 had been treated for epilepsy. (Ped Neur Briefs Sept 1994) [2]. AVMs were supratentorial in 41 (79%) and infratentorial in 11 (21%). The smaller the AVM, the higher the risk of hemorrhage, and the greater the need for early diagnosis and surgical resection. Postoperative angiography is recommended at 1 year after surgery to exclude recurrence, and after 5 years for diffuse AVMs.