title: Risk factors of hematomyelia recurrence and clinical outcome in children with intradural spinal cord arteriovenous malformations.
abstract: OBJECTIVE
  Few published data are available concerning the risk of re-bleeding of spinal cord AVM after an hematomyelia and concerning the long-term clinical outcome. Our aim was to assess the risk of recurrence and long-term clinical outcome after hematomyelia in children with spinal cord AVMs.
  
  
  METHODS
  This single-center retrospective study reviewed the clinical and radiologic data of 28 children younger than 18 years of age with arteriovenous malformation who had experienced at least 1 episode of hematomyelia between 1988 and 2012. Long-term clinical outcome was assessed by the American Spinal Injury Association Impairment Scale, and radiologic review included MR imaging and angioarchitecture on angiography (blinded to clinical information) before treatment and at recurrence.
  
  
  RESULTS
  Sixteen children (57%) experienced 1 episode of hematomyelia, while 12 children (43%) experienced recurrence. Girls and boys were equally affected (sex ratio, 1:1), and mean clinical follow-up was 5.7 ± 4.4 years. The risk of recurrence was higher for AVMs of the cervical and upper thoracic spine, 12 (100%) versus 11 (69%) (P = .01). A high American Spinal Injury Association scale score at last follow-up was reported for 11 children (39%), and the risk of recurrence tended to be associated with poorer functional prognosis (7 [64%] versus 5 [29%], P = .07). At the time of recurrence, perimedullary venous drainage was the main factor associated with recurrence (P = .002). Occlusion rate ≥50% was associated with a decreased risk of recurrence (P = .047).
  
  
  CONCLUSIONS
  In the present series, cervical and upper thoracic spinal cord AVMs and microarchitecture were predictive of the risk of hematomyelia recurrence. Perimedullary venous drainage was one of the main parameters associated with recurrence. Functional prognosis was better in patients with a single episode of hematomyelia.
authors.affiliation: From the Service de Neuroradiologie (G.S., M.S., D.D., A.O.) guillaume.saliou@bct.aphp.fr.
authors.forename: G
authors.initials: G
authors.lastname: Saliou
authors.affiliation: Service de Neurologie Pédiatrique (A.T., M. Tardieu, K.D.).
authors.forename: A
authors.initials: A
authors.lastname: Tej
authors.affiliation: Service de Neurologie (M. Theaudin), Centre Hospitalier Universitaire Bicêtre, National Referral Center for Neurovascular Malformations in Children, Le Kremlin Bicêtre Cedex, France.
authors.forename: M
authors.initials: M
authors.lastname: Theaudin
authors.affiliation: Service de Neurologie Pédiatrique (A.T., M. Tardieu, K.D.).
authors.forename: M
authors.initials: M
authors.lastname: Tardieu
authors.affiliation: From the Service de Neuroradiologie (G.S., M.S., D.D., A.O.).
authors.forename: A
authors.initials: A
authors.lastname: Ozanne
authors.affiliation: From the Service de Neuroradiologie (G.S., M.S., D.D., A.O.).
authors.forename: M
authors.initials: M
authors.lastname: Sachet
authors.affiliation: From the Service de Neuroradiologie (G.S., M.S., D.D., A.O.).
authors.forename: D
authors.initials: D
authors.lastname: Ducreux
authors.affiliation: Service de Neurologie Pédiatrique (A.T., M. Tardieu, K.D.).
authors.forename: K
authors.initials: K
authors.lastname: Deiva
mesh_terms: D001165:Arteriovenous Malformations / Q000000981:diagnostic imaging* / Q000453:epidemiology*; D002675:Child, Preschool; D015897:Comorbidity; D005260:Female; D005602:France / Q000453:epidemiology; D006801:Humans; D015994:Incidence; D008137:Longitudinal Studies; D008297:Male; D011379:Prognosis; D011859:Radiography; D020127:Recovery of Function; D012008:Recurrence; D012307:Risk Factors; D013116:Spinal Cord / Q000098:blood supply* / Q000000981:diagnostic imaging*; D020758:Spinal Cord Vascular Diseases / Q000000981:diagnostic imaging* / Q000453:epidemiology*