Evaluation of pediatric patients with vascular malformations managed with endovascular and radiosurgical techniques using a modified Rankin Disability Scale.
BACKGROUND
Pre- and postoperative evaluation of the pediatric patient with a cerebrovascular malformation can be cumbersome. This may be due to several factors, including age and ability to verbalize. Functional evaluation scales have been devised, yet application to a retrospective study, where information can be limited, may not be possible. Simpler scales, serving the purpose of functional description and categorization would be beneficial in these cases.


METHODS
Between December 1997 and December 2003, 24 patients between the ages of 4 months to 17 years old underwent endovascular treatment for cerebrovascular lesions at our institution. The majority of the arteriovenous malformation cases underwent further radiosurgical treatment. Mean follow-up period from the time of the last endovascular or radiosurgical intervention was 22 months. A pediatric modification of the Rankin Disability Scale was used for evaluation of pre-procedural and post-procedural functional status.


RESULTS
Combined embolization/radiosurgical approach had 4% mortality and 4% morbidity rates. This combined technique achieved a 46% cure in a variety of pediatric vascular anomalies. Overall improvement in disability using the pediatric modification of the Rankin Scale was noted for all of the cases, and a tendency for improvement was noted in the arteriovenous malformation subgroup though not statistically significant, p = 0.0547.


CONCLUSIONS
These results indicate that a pediatric modification of the Rankin Disability Scale can be used for functional evaluation in this population. Although other functional evaluation scales are available and validated, using a Rankin Disability Scale modification is straightforward, and it can provide functional categorization in retrospective studies.
Feliciano
Caleb E
CE
Department of Surgery, Section of Neurological Surgery, Neuroendovascular Surgery Program, University of Puerto Rico, Medical Sciences Campus, San Juan. cfeliciano@rcm.upr.edu
Rodríguez-Mercado
Rafael
R
D000293:Adolescent; D001808:Blood Vessels / Q000002:abnormalities*; D002648:Child; D002675:Child, Preschool; D004621:Embolization, Therapeutic; D005260:Female; D006801:Humans; D007223:Infant; D002538:Intracranial Arteriovenous Malformations / Q000628:therapy*; D008297:Male; D016634:Radiosurgery; D012189:Retrospective Studies