| Purpose: Brain arteriovenous malformation is a common cause of spontaneous intracerebral hemorrhage in children.This study discusses the clinical characteristics and treatments of brain arteriovenous malformation in children,and compares the effects of microsurgical treatment and endovascular embolization in brain arteriovenous malformation in children with acute rupture,so as to promote better diagnosis and treatment plan for children.Materails&Methods: This study selected 41 children with brain arteriovenous malformation who were treated in the Affiliated Hospital of Yangzhou University and Subei People’s Hospital from June 2013 to June 2022 as the study subjects,analyzed the general data,clinical manifestations and imaging characteristics,compared the gender,age,GCS score at admission,Spetzler-Martin grade and postoperative m RS score of the children between microsurgical treatment group and the endovascular embolization group,and the difference in gender,age,GCS score at admission and Spetzler-Martin grade between the good prognosis group and poor prognosis group were compared.Results:(1)Brain arteriovenous malformations were most common in school aged children(48%),with an average age of 10.4 years.There was no significant difference in the incidence rate among different sexes.The proportion of consciousness disorder(71%)was high in children with acute rupture.The clinical manifestations of brain arteriovenous malformations were headache,vomiting and other high intracranial pressure symptoms.Some children had epilepsy,hemiplegia or aphasia.Most of the lesions in children were located in the cerebral lobes,with a high proportion(17%)located in the deep part of the brain.The proportion of children with Spetzler-Martin grade I to II(51%)and Spetzler-Martin grade III to IV(49%)almost the same.(2)The children in the microsurgical treatment group were younger than those in the endovascular embolization group,the Spetzler-Martin grade of b AVM lesions was higher,and the symptoms of consciousness disorder were more serious(p-value<0.05).There was no obvious difference in the gender of children between the groups,and there was no obvious difference in the effect of two different treatment methods on the prognosis of children(p-value>0.05).The children in the poor prognosis group had lower GCS score and higher lesion grade than those in the good prognosis group(p-value<0.05),while there was no obvious difference in the sex and age of children between the groups(p-value>0.05).Conclusion: Once the brain arteriovenous malformation in children ruptured,the onset of bleeding is acute and the symptoms are serious.Compared with adults,children are difficult to tolerate massive blood loss during the operation,the blood vessels are delicate and tender,and the focus often appear at the brain functional area and deep brain,which increases the difficulty of treatment.Both microsurgical treatment and endovascular embolization can achieve good prognosis in low-grade b AVM,both of them are safe and effective,but the children with large hematoma and strong space occupying effect need to clear the intracranial blood quickly at early stage,reduce the space occupying effect,stop the secondary nervous system injury in time and save the children’s lives.In this case,microsurgical treatment is the best choice.Statistical comparison showed that the higher the lesion grade of children,the lower the GCS score at admission,and the greater the possibility of poor prognosis.Pediatric patients with b AVM should be followed up for a long time after treatment to avoid recurrence and deal with long-term postoperative complications timely in order to achieve better prognosis. |
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