Comparative Outcome Of Endovascular Embolization With Microsurgery In Managing Acute Spontaneous Cerebral Hemorrhage In Pediatric Patients, An Institutional Experience

Abstract

Abstract Introduction: A few earlier studies have reported the role of embolization with curative intent in treating the early phase of a spontaneous cerebral hemorrhage of the brain AVM in pediatric patients. its efficacy needs to be compared with microsurgery. The risk factors for hemorrhage following early embolization in such patients should be evaluated. Material & Methods: We analyzed patients treated for arteriovenous malformation in pediatrics (< 18 years) following its rupture in the acute phase by embolization alone and surgery between July 2018 and July 2022. From a pool of 80 patients who had undergone treatment for ruptured AVM with hemorrhage at our center, we identified 36 patients with spontaneous bleeding due to AVMs. Out of which, 20 were treated by embolization alone (Group1) and another group 2 by surgery (with and without adjuvant embolisation). Result: Spetzler martin's grading of the lesion suggested seven lesions<3 and 13 lesions ≥3 in the embolization group; similarly, seven lesions were <3 and nine≥3 Spetzler martin grade in the surgery group. The average midline shift in the embolization group was 2.12±1.68, and in the surgery group was 4.24±2.89 mm(p=0.019). Incomplete embolization was associated with hemorrhage in 2 patients treated with curative intent and 4 in the surgery group treated with embolization as adjuvant (p=0.01). Glasgow outcome score ≥4 was observed in 18 patients in embolization and 12 in the surgery group on follow-up (p=0.273). The average follow-up in the embolization group was 25.80±7.8, and in the surgery group, 29.18±11.85 months (p=0.232). Conclusions: Incomplete embolization is the significant risk factor associated with hemorrhage in AVMs treated following a hemorrhagic stroke in the pediatric age group. Embolization with curative intent in treating such lesions is equally efficacious to the surgery group treated earlier by adjuvant embolization with careful patient selection. Although essential, our results need a further prospective study on a large patient population with longer follow-ups.