title: Associated aneurysms in pediatric arteriovenous malformations and the implications for treatment.
abstract: BACKGROUND
  Arteriovenous malformations (AVM) with associated aneurysms (AA) increase the risk of hemorrhage in adults. Associated aneurysms are thought to develop over time, and the incidence in children, therefore, has been thought to be minimal, although this has not yet been studied.
  
  
  OBJECTIVE
  To define the incidence and morbidity of AA in children and to assess the results of our treatment strategy.
  
  
  METHODS
  Patients younger than 18 years of age with pial AVM seen from 2000 to 2009 were reviewed. Demographics, presentation, hemorrhage, AAs, treatment method, and outcome were analyzed.
  
  
  RESULTS
  Of 144 patients with AVM, 30 were younger than 18 years of age. AA was identified in 5 of 30 children (16.7%) and 33 of 114 adults (28.9%; P = .25). Mean age at presentation in children was 11.67 years (range, 6 months to 17 years), and mean follow-up was 28.8 months (range, 1-75 months). Hemorrhage at presentation was seen in 80% of patients with AA and 72% with AVM alone. Emergent therapy was required in 60% of patients with AA and 40% with AVM alone (P = .63). Time to treatment was 4.3 days with AA and 27.3 days without (P = .42). There was no difference in outcome between patients with AA and those with AVM alone.
  
  
  CONCLUSIONS
  The incidence of pediatric AA was higher in our series than projected in the current literature. Time to treatment was shorter in children with AA compared with those with AVM alone, although there was no difference in clinical outcome. Although hemorrhage rates were similar, emergent therapy was required more often in patients with AA. Our findings support the need for early diagnosis and treatment of associated aneurysms in children.
authors.affiliation: Department of Neurological Surgery, Weill Cornell Medical College, New York, New York 10021, USA.
authors.forename: Caitlin
authors.initials: C
authors.lastname: Hoffman
authors.forename: Howard A
authors.initials: HA
authors.lastname: Riina
authors.forename: Philip
authors.initials: P
authors.lastname: Stieg
authors.forename: Baxter
authors.initials: B
authors.lastname: Allen
authors.forename: Y Pierre
authors.initials: YP
authors.lastname: Gobin
authors.forename: Alejandro
authors.initials: A
authors.lastname: Santillan
authors.forename: Mark
authors.initials: M
authors.lastname: Souweidane
mesh_terms: D000293:Adolescent; D002533:Cerebral Angiography; D002543:Cerebral Hemorrhage / Q000453:epidemiology / Q000209:etiology / Q000628:therapy; D002648:Child; D002675:Child, Preschool; D004621:Embolization, Therapeutic; D057510:Endovascular Procedures; D005260:Female; D006801:Humans; D015994:Incidence; D007223:Infant; D002532:Intracranial Aneurysm / Q000150:complications* / Q000453:epidemiology* / Q000628:therapy; D002538:Intracranial Arteriovenous Malformations / Q000150:complications* / Q000628:therapy; D008297:Male; D012189:Retrospective Studies