title: Angioarchitectural Risk Factors for Hemorrhage and Clinical Long-Term Outcome in Pediatric Patients with Cerebral Arteriovenous Malformations.
abstract: BACKGROUND
  Intracranial arteriovenous malformation (AVM) in children is a rare diagnosis. Little is known about factors determining AVM rupture and appropriate treatment strategies to prevent hemorrhage and associated disability. Available data suggest that children are subject to an increased risk for AVM rupture compared with adults.
  
  
  METHODS
  In 46 pediatric patients with AVM, demographic factors, clinical presentation, angioarchitectural features, and treatment regimens as well as clinical and radiologic outcomes were retrospectively analyzed. First-line treatment option was microsurgical resection of the disease, with or without preoperative embolization.
  
  
  RESULTS
  Twenty-four boys (52.2%) and 22 girls (47.8%) with a mean age on admission of 12.4 years (4-18 years) were included. Mean follow-up was 4 years (median, 1.5; range, 0.1-16.4). Thirty-one children presented with intracerebral hemorrhage (67.4%). Small AVMs (<3 cm) ruptured in 83.3% (n = 25) and were shown to be more prone to hemorrhage than larger ones (P < 0.01). Small AVM size (P < 0.01; odds ratio [OR], 0.12; 95% confidence interval [CI] 0.02-0.59) and exclusive deep venous drainage (P < 0.01; OR, 29.74; 95% CI, 2.45-4445.34) were independent risk factors for hemorrhage in the presented cohort. Good long-term outcome was associated with a high score on the Glasgow Coma Scale on admittance (P < 0.05; OR, 0.148; 95% CI, 0.03-0.73).
  
  
  CONCLUSIONS
  Two-thirds of children with AVM are admitted with intracerebral hemorrhage. Microsurgical resection was successful as confirmed by radiologic studies in 95%, and 79.5% of patients presented in a good clinical condition on follow-up (modified Rankin Scale 0 or 1). Microsurgical treatment is recommended if the lesion is accessible and angioarchitectural risk factors favor definitive treatment.
authors.affiliation: Department of Neurosurgery, University Hospital Hamburg Eppendorf, Hamburg, Germany. Electronic address: mareitz@uke.de.
authors.forename: Matthias
authors.initials: M
authors.lastname: Reitz
authors.affiliation: Department of Neurosurgery, University Hospital Hamburg Eppendorf, Hamburg, Germany.
authors.forename: Niklas
authors.initials: N
authors.lastname: von Spreckelsen
authors.affiliation: Department of Statistic Biometry and Epidemiology, University Hospital Hamburg Eppendorf, Hamburg, Germany.
authors.forename: Eik
authors.initials: E
authors.lastname: Vettorazzi
authors.affiliation: Department of Neurosurgery, University Hospital Hamburg Eppendorf, Hamburg, Germany.
authors.forename: Till
authors.initials: T
authors.lastname: Burkhardt
authors.affiliation: Department of Neuroradiology, University Hospital Hamburg Eppendorf, Hamburg, Germany.
authors.forename: Ulrich
authors.initials: U
authors.lastname: Grzyska
authors.affiliation: Department of Neuroradiology, University Hospital Hamburg Eppendorf, Hamburg, Germany.
authors.forename: Jens
authors.initials: J
authors.lastname: Fiehler
authors.affiliation: Department of Neurosurgery, University Hospital Hamburg Eppendorf, Hamburg, Germany.
authors.forename: Nils Ole
authors.initials: NO
authors.lastname: Schmidt
authors.affiliation: Department of Neurosurgery, University Hospital Hamburg Eppendorf, Hamburg, Germany.
authors.forename: Manfred
authors.initials: M
authors.lastname: Westphal
authors.affiliation: Department of Neurosurgery, University Hospital Hamburg Eppendorf, Hamburg, Germany.
authors.forename: Jan
authors.initials: J
authors.lastname: Regelsberger
mesh_terms: D000293:Adolescent; D015901:Angiography, Digital Subtraction; D001921:Brain / Q000098:blood supply / Q000000981:diagnostic imaging; D002533:Cerebral Angiography; D002543:Cerebral Hemorrhage / Q000000981:diagnostic imaging* / Q000453:epidemiology / Q000209:etiology* / Q000503:physiopathology; D002648:Child; D002675:Child, Preschool; D003287:Contrast Media; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D002538:Intracranial Arteriovenous Malformations / Q000000981:diagnostic imaging* / Q000453:epidemiology / Q000503:physiopathology / Q000601:surgery*; D008279:Magnetic Resonance Imaging; D008297:Male; D015999:Multivariate Analysis; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D003287:Contrast Media
keywords: AVM; Angioarchitecture; Clinical outcome; Pediatric arteriovenous malformations