gms | German Medical Science

Objective: Dealing with pediatric AVM patients is challenging due to the rare number of patients presenting with brain AVMs and consequently little knowledge about adequate treatment approaches. We here identify angioarchitectural risk factors for hemorrhage, demonstrate treatment options and display overall long-term outcome for pediatric AVM patients.

Method: 46 pediatric patients were extracted from our AVM database. Patients younger than 18 years of age with angiographically confirmed cerebral AVM were included and data analyzed focussing on clinical history, demographic and angiographic factors, treatment measures and clinical as well as radiographic outcome. Multivariate analysis was performed to verify significant coherences between angiographic risk factors and bleeding rates. Univariate analysis was used to assign factors significantly associated with clinical outcome.

Results: 46 children (24 males, 52.2%) with a mean age of 12.4 years were included. 31 of 46 patients suffered from hemorrhage at admission (67.4%). Exclusive deep venous drainage (29.74; 2.45–4445.34; 0.0042) as well as small angioma size (<3cm) (0.12; 0.02–0.59; 0.0075) were shown to depict independent risk factors significantly associated with hemorrhage at presentation (odds ratio, 95% CI and p-value). 20 patients (43.5%) were treated by microsurgery only and 13 children (28.3%) treated in a combined fashion with embolization and subsequent microsurgical resection. Overall, good outcome was assessed in 30 out of 44 patients (68.2%, mRS 0 or 1, mean follow-up 48.3 months, 2 patients lost to follow-up). Complete radiographic extirpation of the AVM was achieved in 30 of 33 curably treated patients. Prognostic factors for poor outcome (mRS<2) were shown to be deep location of the AVM (p=<0.05), poor GCS on admission (p=<0.001) and high SM-Grade (p=<0.05).

Conclusions: Risk factors for hemorrhage in pediatric AVM patients depict exclusive deep venous drainage and small nidus size of the AVM. If possible, patients should thus be treated by a straight forward approach (microsurgery and/or endovascular occlusion) aiming at the immediate and complete extirpation oft he AVM.