Intracranial and Intraspinal Vascular Anomalies in Children

Abstract

'EW diagnostic, anesthetic, and operative techniques have continued to improve the results of surgical treatment of intracranial vascular anomalies. Since Olivecrona and Ladenheim 14 advocated complete excision of anteriovenous malformations whenever possible, considerable attention has been directed toward this problem, and considerable progress has been achieved. The classification provided by Pool and Potts is follows closely that of Olivecrona 1~ and others. They distinguished arteriovenous malformations, capillary and venous angiomas, cavernous angiomas, and capillary telangiectases, with arteriovenous malformations the most common. Svien and McRae 22 favored conservative treatment; Pool 1G-18 and Perret and Nishioka 1~ did not. Conservative treatment consists of doing nothing or giving x-ray therapy. Surgical treatment includes total resection, ligation of feeding arteries, embolization, 1~ coagulation of vessels, and carotid ligation in the neck; the latter is probably ineffective and may actually be detrimental. 2I Moderate and deep hypothermia, hypotension, and cryosurgery have been used2 Most authorities feel that hemorrhage from an arteriovenous malformation, particularly in a voung patient, is an indication for resection if the malformation is suitably located, and there is no real danger of creating or increasing the neurological deficit. Prophylactic resection when hemorrhage has not occurred is not generally thought wise, and the risks involved have to be weighed against the 10% mortality of initial hemorrhage. Certainly, resection for the purpose of alleviating seizures would not be considered a valid indication.