gms | German Medical Science

Objective: Pediatric patients constitute an unqiue subgroup of all cerebral AVM cases. Management of pediatric AVMs requires profound knowledge regarding the natural history of the lesion as well as associated treatment risks. Identification of children with AVMs that are more prone to bleed provides treating physicians with precious information influencing treatment planning.

Method: 44 patients younger than 18 years with angiographically verified cerebral AVM and cross sectional imaging were included into the study. Data were retrospectively analyzed from 1991 to 2012 regarding bleeding rates at presentation, demographic factors, clinical history and angioarchitectural AVM features including Spetzler Martin grade, AVM location, arterial feeder architecture and territorial supply, venous drainage as well as associated aneurysms. Multivariate analysis was performed to identify significant coherences between bleeding rates and analyzed angioarchitectural factors.

Results: 44 children (20 males, 45.5%) with a mean age of 12.6 years were included. 30 of 44 patients presented with hemorrhage (68.2%), other manifestations included the coincidental finding of the AVM (n=5, 11.4%), headaches (n=4, 9.1%) or seizures (n=5, 11.4%). 4 patients presented with infratentorial AVMs (9.1%), in 8 children (18.2%) the lesion was located at the basal ganglia or the corpus callosum. AVM related aneurysms were identified in 7 children with a cerebral AVM (15.9%). In the majority of cases (21 patients, 47.7%), AVMs were supplied by three or more arterial feeders with angioma size mostly accounting for 0-3cm (n=29, 65.9%) or 3–6 cm (n=13, 29.5%). When analyzing involved cerebral vessel territories, most AVMs were supplied by vessels from either one (n=21, 47.7%) or two territories (n=16, 36.4%). Multivariate analysis (odds ratio, 95% CI and p-value) showed independent associations of deep vs. superficial venous drainage of AVMs (18.182; 1.196–250.0; 0.0409) and inverse association between number of supplying vessel territories (0.131; 0.032–0.535; 0.0016) and hemorrhage at presentation.

Conclusions: Risk factors for intracerebral hemorrhage in the presented pediatric AVM cohort depict exclusive deep venous drainage and single territorial blood supply of the AVM. Due to the augmented bleeding risk in these cases, aggressive treatment options aiming at the total removal of the lesion should be considered preferably.