Clinical Use of CTA-Guided Emergency Microsurgical Resection of Ruptured Cerebral Arteriovenous Malformations in Pediatric Patients.

[OBJECTIVE] The aim of this study was to assess the clinical use and therapeutic efficacy of computed tomography angiography (CTA) in guiding emergency microsurgical resection of ruptured cerebral arteriovenous malformations (AVMs) in pediatric patients.

[METHODS] We retrospectively analyzed 30 children with ruptured intracranial AVMs who underwent microsurgical resection between 2019 and 2025. All patients received admission CTA, which guided surgical planning. Emergency hematoma evacuation and AVM resection were performed. Outcomes were evaluated using mRS at discharge and 6 months. Follow-up imaging was conducted at 6 months and annually, with at least 1 year of follow-up.

[RESULTS] CTA demonstrated a 100% detection rate in identifying AVMs across all 30 patients. Complete AVM resection was achieved in each case, with no postoperative residual lesions observed. No deterioration in preoperative neurological symptoms was recorded. Postoperative complications were observed in 4 patients: 3 developed epilepsy, which was controlled with antiepileptic therapy, and one experienced an intracranial infection, which resolved with conservative management. No cases of rebleeding or AVM recurrence were identified during follow-up. Favorable functional outcomes (mRS <3) were noted in 29 patients (96%), while one patient (4%) had an unfavorable outcome (mRS ≥3).

[CONCLUSIONS] CTA demonstrated high diagnostic sensitivity and anatomical accuracy in pediatric cerebral AVMs, facilitating prompt and targeted emergency microsurgical intervention. The use of CTA-guided management contributed to complete lesion resection and favorable postoperative outcomes.