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

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 i...

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Veröffentlicht in:Child's nervous system 2023-04, Vol.39 (4), p.975-982
Hauptverfasser: Pepper, Joshua, Lamin, Saleh, Thomas, Allan, Walsh, A. Richard, Rodrigues, Desiderio, Lo, William B., Solanki, Guirish A.
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container_end_page 982
container_issue 4
container_start_page 975
container_title Child's nervous system
container_volume 39
creator Pepper, Joshua
Lamin, Saleh
Thomas, Allan
Walsh, A. Richard
Rodrigues, Desiderio
Lo, William B.
Solanki, Guirish A.
description 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.
doi_str_mv 10.1007/s00381-022-05800-4
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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.</description><identifier>ISSN: 0256-7040</identifier><identifier>EISSN: 1433-0350</identifier><identifier>DOI: 10.1007/s00381-022-05800-4</identifier><identifier>PMID: 36580118</identifier><language>eng</language><publisher>Berlin/Heidelberg: Springer Berlin Heidelberg</publisher><subject>Adolescent ; Child ; Child, Preschool ; Follow-Up Studies ; Humans ; Infant ; Intracranial Arteriovenous Malformations - complications ; Intracranial Arteriovenous Malformations - diagnostic imaging ; Intracranial Arteriovenous Malformations - therapy ; Intracranial Hemorrhages - surgery ; Medicine ; Medicine &amp; Public Health ; Neurosciences ; Neurosurgery ; Original Article ; Prognosis ; Radiosurgery - methods ; Retrospective Studies ; Treatment Outcome</subject><ispartof>Child's nervous system, 2023-04, Vol.39 (4), p.975-982</ispartof><rights>The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature 2022. Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.</rights><rights>2022. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c347t-ef437c050ab71d9d16feccff1324af6306f4f71763d6feba2080e15163bc4ce83</citedby><cites>FETCH-LOGICAL-c347t-ef437c050ab71d9d16feccff1324af6306f4f71763d6feba2080e15163bc4ce83</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://link.springer.com/content/pdf/10.1007/s00381-022-05800-4$$EPDF$$P50$$Gspringer$$H</linktopdf><linktohtml>$$Uhttps://link.springer.com/10.1007/s00381-022-05800-4$$EHTML$$P50$$Gspringer$$H</linktohtml><link.rule.ids>314,780,784,27924,27925,41488,42557,51319</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/36580118$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Pepper, Joshua</creatorcontrib><creatorcontrib>Lamin, Saleh</creatorcontrib><creatorcontrib>Thomas, Allan</creatorcontrib><creatorcontrib>Walsh, A. Richard</creatorcontrib><creatorcontrib>Rodrigues, Desiderio</creatorcontrib><creatorcontrib>Lo, William B.</creatorcontrib><creatorcontrib>Solanki, Guirish A.</creatorcontrib><title>Clinical features and outcome in pediatric arteriovenous malformation: institutional multimodality treatment</title><title>Child's nervous system</title><addtitle>Childs Nerv Syst</addtitle><addtitle>Childs Nerv Syst</addtitle><description>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.</description><subject>Adolescent</subject><subject>Child</subject><subject>Child, Preschool</subject><subject>Follow-Up Studies</subject><subject>Humans</subject><subject>Infant</subject><subject>Intracranial Arteriovenous Malformations - complications</subject><subject>Intracranial Arteriovenous Malformations - diagnostic imaging</subject><subject>Intracranial Arteriovenous Malformations - therapy</subject><subject>Intracranial Hemorrhages - surgery</subject><subject>Medicine</subject><subject>Medicine &amp; Public Health</subject><subject>Neurosciences</subject><subject>Neurosurgery</subject><subject>Original Article</subject><subject>Prognosis</subject><subject>Radiosurgery - methods</subject><subject>Retrospective Studies</subject><subject>Treatment Outcome</subject><issn>0256-7040</issn><issn>1433-0350</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2023</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNp9kMtOAyEUQInR2Pr4ARdmlm5GL4951J1pfCUmbnRNKHMxNDBUYEz8e6lVl64IueceyCHkjMIlBeiuEgDvaQ2M1dD0ALXYI3MqOK-BN7BP5sCatu5AwIwcpbQGoE3PFodkxtvCU9rPiVs6O1qtXGVQ5SliqtQ4VGHKOnis7FhtcLAqR6srFTNGGz5wDFOqvHImRK-yDeN1AVO2edpeistPLlsfBuVs_qxyLGqPYz4hB0a5hKc_5zF5vbt9WT7UT8_3j8ubp1pz0eUajeCdhgbUqqPDYqCtQa2NoZwJZVoOrRGmo13LhzJZKQY9IG1oy1daaOz5MbnYeTcxvE-YsvQ2aXROjVi-LlnXLFhbHtmibIfqGFKKaOQmWq_ip6Qgt5XlrrIsleV3ZSnK0vmPf1p5HP5WfrMWgO-AVEbjG0a5DlMsZdJ_2i_ru4tA</recordid><startdate>20230401</startdate><enddate>20230401</enddate><creator>Pepper, Joshua</creator><creator>Lamin, Saleh</creator><creator>Thomas, Allan</creator><creator>Walsh, A. Richard</creator><creator>Rodrigues, Desiderio</creator><creator>Lo, William B.</creator><creator>Solanki, Guirish A.</creator><general>Springer Berlin Heidelberg</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope></search><sort><creationdate>20230401</creationdate><title>Clinical features and outcome in pediatric arteriovenous malformation: institutional multimodality treatment</title><author>Pepper, Joshua ; Lamin, Saleh ; Thomas, Allan ; Walsh, A. 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subjects Adolescent
Child
Child, Preschool
Follow-Up Studies
Humans
Infant
Intracranial Arteriovenous Malformations - complications
Intracranial Arteriovenous Malformations - diagnostic imaging
Intracranial Arteriovenous Malformations - therapy
Intracranial Hemorrhages - surgery
Medicine
Medicine & Public Health
Neurosciences
Neurosurgery
Original Article
Prognosis
Radiosurgery - methods
Retrospective Studies
Treatment Outcome
title Clinical features and outcome in pediatric arteriovenous malformation: institutional multimodality treatment
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