title: Hemorrhage Risk in Pediatric Patients with Multiple Intracranial Arteriovenous Malformations.
abstract: OBJECTIVE
  This study aims to characterize the clinical features, treatment strategies, and annual hemorrhage incidence rate of pediatric patients with multiple arteriovenous malformations (MAVM).
  
  
  METHODS
  The PubMed and EMBASE databases and the arteriovenous malformations (AVM) database at the Johns Hopkins Hospital were searched for reports of pediatric patients (under 21 years of age) with MAVM. Data related to demographics, clinical features, management, and treatment outcomes were analyzed using descriptive statistics. Twenty-four pediatric patients met the inclusion criteria.
  
  
  RESULTS
  The annual hemorrhage incidence rate was 2.1%. The most common presenting features were neurological deficit (38%) and hemorrhage (21%). Treatment with embolization has become the most frequently used modality. In patients undergoing staged treatment of MAVM, hemorrhage of an untreated nidus (n = 1), visualization of a new nidus (n = 2), or disappearance of a draining vein (n = 1) occurred.
  
  
  CONCLUSIONS
  The annual hemorrhage incidence rate for pediatric patients with MAVM approaches the upper range of previously reported hemorrhage rates for solitary AVM. A staged approach to treating MAVM requires close follow-up as changes to the remaining nidi may occur during the latency period. Limitations of this study include its small sample size and reporting bias.
authors.affiliation: Department of Neuroscience, Johns Hopkins School of Medicine, Baltimore, Md., USA.
authors.forename: Christine
authors.initials: C
authors.lastname: Boone
authors.forename: Justin M
authors.initials: JM
authors.lastname: Caplan
authors.forename: Tomas
authors.initials: T
authors.lastname: Garzon-Muvdi
authors.forename: Wuyang
authors.initials: W
authors.lastname: Yang
authors.forename: Xiaobu
authors.initials: X
authors.lastname: Ye
authors.forename: Mari L
authors.initials: ML
authors.lastname: Groves
authors.forename: Rafael J
authors.initials: RJ
authors.lastname: Tamargo
authors.forename: Edward S
authors.initials: ES
authors.lastname: Ahn
authors.forename: Judy
authors.initials: J
authors.lastname: Huang
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D004621:Embolization, Therapeutic; D005500:Follow-Up Studies; D006470:Hemorrhage / Q000209:etiology*; D006801:Humans; D007223:Infant; D002538:Intracranial Arteriovenous Malformations / Q000150:complications*; D016634:Radiosurgery; D012189:Retrospective Studies; D016896:Treatment Outcome; D055815:Young Adult