Abstracts

Rationale: Neurovascular lesions are rare and understudied in the pediatric population. Their initial presentation can range from seizure, to focal neurologic deficits as well as headaches. The goal of this study was to examine the initial clinical presentation of neurovascular lesions in children and assess the long-term post-surgical seizure freedom following neurovascular corrective surgery. Methods: We reviewed all the pediatric patients with neurovascular lesions that were diagnosed between 2006- 2011 at the University of Alberta hospital, Edmonton, Canada. Initial presentation and brain imaging were reviewed to classify the specific type of neurovascular lesion. Long-term epilepsy and post-surgical outcome was also assessed. Results: Of the 10 patients, 7/10 patients had an initial presentation of focal seizures, while 2 patients presented with headaches and 1 presented with visual field defects. Clinical presentation appears to be independent of the type of neurovascular lesion. In this study, 5/10 patients had cavernous angiomas (CAM) and 4 had arteriovenous malformation (AVM). One patient with an arteriovenous fistula (AV fistula) presented with visual field defects and was inoperable. Of note, all of the patients with CAM and 2 of the patients with AVM presented with seizures. The other 2 AVM patients presented with sudden onset thunderclap headaches. Following neurovascular corrective surgery, all 7 patients with initial presentation of focal seizures required long term antiepileptic treatment. There were no surgical complications. Conclusions: In this novel case series we have described the initial presentation of pediatric neurovascular lesions as often involving focal seizures. Furthermore, unlike our pediatric epilepsy surgical patients (of other causes), seizure freedom following neurovascular corrective surgery is limited and patients require long term antiepileptic treatment. The mechanism of increased epileptogenic potential in this population is unknown. While we present a small case series, our results suggest larger studies are needed with long term follow up. Funding: The mechanism of increased epileptogenic potential in this population is unknown. While we present a small case series, our results suggest larger studies are needed with long term follow up.