Surgical treatment of children with intracranial hemorrhage in the acute period due to ruptured vascular malformation

Background. Rupture of arteriovenous malformation remains one of the leading causes of intracranial hemorrhage in children, accompanied by a high mortality rate and marked neurological disorders. Despite the advances in pediatric neurosurgery, the optimal tactics of surgical intervention in the acute period remains a matter of debate. This study is aimed at making a comparative analysis of different surgical methods, assessing their effectiveness, and identifying key factors determining clinical prognosis. Methods. The work is based on a retrospective analysis of medical records of 78 children with a confirmed diagnosis of intracranial hemorrhage due to ruptured cerebral AVM. The study evaluated various surgical techniques, including microsurgical malformation evacuation, endovascular interventions, craniotomy, radiosurgery, and their combinations. The effectiveness of these techniques was analyzed taking into account clinical outcomes, postoperative complications, and imaging data (CT, MRI). Results. The most favorable outcomes were recorded in patients (n=32) who underwent simultaneous hematoma evacuation and AVM resection. Meanwhile, endovascular interventions and decompressive craniotomy without malformation removal did not provide such a pronounced clinical improvement in most cases. Brain dislocation exceeding 1 cm was found to be correlated with an increased robability of severe neurological disorders and lethal outcome. Conclusion. The results of this study confirm that radical surgical treatment, especially in the acute period, significantly improves functional outcomes and reduces the risk of complications. The presence of brain dislocation of more than 1 cm can be considered as a significant prognostic factor of unfavorable outcome. The choice of optimal surgical tactics should take into account the location of malformation, the volume of hemorrhage, and the overall severity of the patient's condition, which will improve the efficacy of treatment and minimize adverse outcomes.