2026 Poster Presentations
P487: ADVANCES IN THE MULTIMODAL MANAGEMENT OF PEDIATRIC ARTERIOVENOUS MALFORMATIONS AND FISTULAS: A 10-YEAR REVIEW
Mehrdad Pahlevani1; Ammar Saloum2; Denise Baloi2; Yusor y Al-Nuaim3; Michael Karsy4; Brandon Lucke-Wold5; 1Jamaica Hospital Medical Center; 2College of Human Medicine, Michigan State University; 3College of Medicine, Ajman University, United Arab Emirates; 4Department of Neurosurgery, University of Michigan, Ann Arbor; 5Department of Neurosurgery, University of Florida, Gainesville
Introduction: Pediatric arteriovenous malformations (pAVMs) and arteriovenous fistulas (AVFs) are rare but potentially life-threatening vascular anomalies characterized by direct arteriovenous connections. Their management in children poses unique challenges due to limited data, variable presentations, and dependence on institutional expertise. Over the past decade, advancements in endovascular, microsurgical, and radiosurgical techniques have significantly reshaped treatment strategies.
Methods: A comprehensive review of the literature from 2014 to 2025 was conducted, focusing on pediatric AVM and AVF management. Eligible studies included case series, cohort studies, case control studies, and case reports involving three or more patients. Articles were selected based on relevance to therapeutic approaches and clinical outcomes in the pediatric population.
Results: A multimodal approach—integrating embolization, microsurgical resection, and radiosurgery— was frequently employed for complex or ruptured AVMs. Endovascular embolization has emerged as both a definitive and adjunctive therapy. Radiosurgery demonstrated particular efficacy for smaller, deep-seated, and unruptured lesions. Treatment outcomes varied depending on lesion size, location, rupture status, and patient age. While recent techniques have enhanced safety and efficacy, recurrence and rebleeding—particularly in incompletely treated AVMs— remain key concerns.
Conclusion: The management of pediatric AVMs and AVFs has undergone considerable evolution, emphasizing individualized, multidisciplinary care. Despite promising advancements, there remains a pressing need for prospective pediatric-focused studies to standardize treatment protocols and better understand long-term outcomes.