Faculty Collaboration Database

Outcomes of Multimodality Therapy in Pediatric Patients With Ruptured and Unruptured Brain Arteriovenous Malformations. Neurosurgery 2016 May;78(5):695-707

Date

10/29/2015

Pubmed ID

26509647

DOI

10.1227/NEU.0000000000001076

Scopus ID

2-s2.0-84945529732 (requires institutional sign-in at Scopus site)   35 Citations

Abstract

BACKGROUND: Brain arteriovenous malformations (BAVMs) are a frequent cause of pediatric hemorrhagic stroke, which frequently results in significant morbidity and mortality.

OBJECTIVE: To analyze the results of multimodality treatment for a consecutive series of pediatric patients with ruptured and unruptured BAVMs at a single institution.

METHODS: Forty patients <18 years of age were retrospectively reviewed. Results were divided by hemorrhage status, ie, ruptured or unruptured, and the intended curative treatment modality, ie, surgical resection or stereotactic radiosurgery.

RESULTS: Twenty-seven patients (68%) presented with hemorrhage, and 13 patients (32%) presented without hemorrhage. Among ruptured patients, 19 (70%) underwent surgery and 8 (30%) underwent stereotactic radiosurgery. In surviving patients who presented with hemorrhage, 23 of 26 (88%) had a modified Rankin Scale (mRS) score of 0 to 2 at the last follow-up, and 24 of 26 (92%) obtained radiographic cure. For unruptured BAVMs, all 6 patients with grade I to III BAVM obtained radiographic cure and had an mRS score of 0 to 1 at the last follow-up, whereas 1 of 5 patients (20%) with grade IV and V BAVM had BAVM obliteration and a mean mRS score of 1.8 at the last follow-up. In a total of 93.6 years of follow-up from date of presentation to last clinical follow-up, there was 1 hemorrhage (1.1%/y). Of 30 patients with radiographic obliteration, 2 patients had radiographic recurrence (7% incidence).

CONCLUSION: The majority of ruptured patients had an mRS score of 0 to 2 at the last follow-up and obtained radiographic cure. Unruptured patients with grade I to III BAVMs had superior outcomes compared with those with grade IV and V AVMs. Treatment of grade I to III BAVMs appears safe, and additional study is needed to determine optimal strategies for the management of unruptured grade IV and V BAVMs.

Author List

Nerva JD, Kim LJ, Barber J, Rockhill JK, Hallam DK, Ghodke BV, Sekhar LN

Author

John D. Nerva MD Assistant Professor in the Neurosurgery department at Medical College of Wisconsin

MESH terms used to index this publication - Major topics in bold

Adolescent
Cerebral Angiography
Cerebral Revascularization
Child
Child, Preschool
Combined Modality Therapy
Female
Follow-Up Studies
Humans
Infant
Infant, Newborn
Intracranial Arteriovenous Malformations
Intracranial Hemorrhages
Male
Microsurgery
Radiosurgery
Retrospective Studies
Rupture, Spontaneous
Tomography, X-Ray Computed
Treatment Outcome