Angioarchitectural risk factors for hemorrhage and clinical long-term outcome in pediatric patients with cerebral arteriovenous malformations
- Hamburg Center of Neuroscience (HCNS)
- AG Statistische Beratung (143)
BACKGROUND: Intracranial arteriovenous malformation (AVM) in children is a rare diagnosis. Little is known about factors determining AVM rupture and appropriate treatment strategies to prevent hemorrhage and associated disability. Available data suggest that children are subject to an increased risk for AVM rupture compared to adults.
METHODS: In 46 pediatric AVM patients, demographic factors, clinical presentation, angioarchitectural features, treatment regimens as well as clinical and radiological outcomes were retrospectively analyzed. First-line treatment option was the microsurgical resection of the pathology, with or without preoperative embolization.
RESULTS: 24 males (52.2%) and 22 females (47.8%) with a mean age on admission of 12.4 years (4-18 years) were included. Mean follow-up was 4 years (median 1.5; range 0.1-16.4). 31 children presented with intracerebral hemorrhage (67.4%). Small AVMs (<3 cm) ruptured in 83.3% (n=25) and were shown to be more prone to hemorrhage than larger ones (p<.01). Small AVM size (p<.01; OR .12; 95% CI .02, .59) and exclusive deep venous drainage (p<.01; OR 29.74; 95% CI 2.45, 4445.34) were independent risk factors for hemorrhage in the presented cohort. Good long-term outcome was associated with a high score on the Glasgow Coma Scale (GCS) on admittance (p<.05; OR .148; 95% CI .03, .73;).
CONCLUSION: Two-thirds of children with AVM are admitted with intracerebral hemorrhage. Microsurgical resection was successful as confirmed by radiological studies in 95% and 79.5% of patients presented in a good clinical condition on follow-up (mRS 0 or 1). Microsurgical treatment is recommended if the lesion is accessible and angioarchitectural risk factors favor definitive treatment.
- Forschungsinformationssystem des UKE