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Clinical features and outcome in pediatric arteriovenous malformation: institutional multimodality treatment

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Abstract

Purpose

Intracranial arteriovenous-malformation (AVM) is a relatively rare condition in pediatrics, yet is a major cause of spontaneous intracranial hemorrhage with a risk of fatal hemorrhage reported to be between 4 and 29%. Little is known about vessel morphology and optimum treatment modalities including multimodality combination therapy and prognosis in children.

Methods

A retrospective review of all children presenting to our institution from 2006 to 2020 that had an AVM was undertaken.

Results

A total of 50 children were identified with median age of 11 (range 1–16) years. The mean follow-up was 7.6 years. Forty-one children presented as an emergency and of those, 40 had hemorrhage identified on initial brain imaging. The average nidus size was 25 mm, drainage was superficial in 51% of cases, and located in eloquent cortex in 56%. The supplemental Spetzler-Martin grading indicated 78% (39/50) were grade 4 and above (moderate to high risk). Primary treatment modalities included embolization in 50% (25) or SRS in 30% (15) and surgery in 20% (10).The AVM was obliterated on follow-up DSA in 66% children. Three children had post-treatment hemorrhage, two related to embolization and one the day following SRS, giving a re-bleed rate of 6%. The GOSE was available for 32 children at long term follow and 94% had a good outcome (GOSE 5–8). Two children died due to acute hemorrhage (4%).

Conclusion

The majority of children with AVM present with hemorrhage. The rebleed rate during definitive treatment is low at 6% over the study period. The selective use of the 3 modalities of treatment has significantly reduced mortality and severe disability.

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Authors and Affiliations

  1. Birmingham Women’s & Children’s Hospital, Birmingham, UK

    Joshua Pepper, Saleh Lamin, Allan Thomas, A. Richard Walsh, Desiderio Rodrigues, William B. Lo & Guirish A. Solanki

  2. Queen Elizabeth Hospital, University Hospitals Birmingham, Birmingham, UK

    Saleh Lamin & Allan Thomas

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All authors contributed to the study conception and design. The first draft of the manuscript was written by Joshua Pepper and critically revised by all authors. All Authors read and approved the final manuscript.

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Pepper, J., Lamin, S., Thomas, A. et al. Clinical features and outcome in pediatric arteriovenous malformation: institutional multimodality treatment. Childs Nerv Syst 39, 975–982 (2023). https://doi.org/10.1007/s00381-022-05800-4

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