Angioarchitectural risk factors for hemorrhage and clinical long-term outcome in pediatric patients with cerebral arteriovenous malformations
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Angioarchitectural risk factors for hemorrhage and clinical long-term outcome in pediatric patients with cerebral arteriovenous malformations. / Reitz, Matthias; von Spreckelsen, Niklas; Vettorazzi, Eik; Burkhardt, Till; Grzyska, Ulrich; Fiehler, Jens; Schmidt, Nils Ole; Westphal, Manfred; Regelsberger, Jan.
in: WORLD NEUROSURG, Jahrgang 89, 17.02.2016, S. 540-51.Publikationen: SCORING: Beitrag in Fachzeitschrift/Zeitung › SCORING: Zeitschriftenaufsatz › Forschung › Begutachtung
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T1 - Angioarchitectural risk factors for hemorrhage and clinical long-term outcome in pediatric patients with cerebral arteriovenous malformations
AU - Reitz, Matthias
AU - von Spreckelsen, Niklas
AU - Vettorazzi, Eik
AU - Burkhardt, Till
AU - Grzyska, Ulrich
AU - Fiehler, Jens
AU - Schmidt, Nils Ole
AU - Westphal, Manfred
AU - Regelsberger, Jan
N1 - Copyright © 2015 Elsevier Inc. All rights reserved.
PY - 2016/2/17
Y1 - 2016/2/17
N2 - 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 to adults.METHODS: In 46 pediatric AVM patients, demographic factors, clinical presentation, angioarchitectural features, treatment regimens as well as clinical and radiological outcomes were retrospectively analyzed. First-line treatment option was the microsurgical resection of the pathology, with or without preoperative embolization.RESULTS: 24 males (52.2%) and 22 females (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). 31 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<.01). Small AVM size (p<.01; OR .12; 95% CI .02, .59) and exclusive deep venous drainage (p<.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 (GCS) on admittance (p<.05; OR .148; 95% CI .03, .73;).CONCLUSION: Two-thirds of children with AVM are admitted with intracerebral hemorrhage. Microsurgical resection was successful as confirmed by radiological studies in 95% and 79.5% of patients presented in a good clinical condition on follow-up (mRS 0 or 1). Microsurgical treatment is recommended if the lesion is accessible and angioarchitectural risk factors favor definitive treatment.
AB - 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 to adults.METHODS: In 46 pediatric AVM patients, demographic factors, clinical presentation, angioarchitectural features, treatment regimens as well as clinical and radiological outcomes were retrospectively analyzed. First-line treatment option was the microsurgical resection of the pathology, with or without preoperative embolization.RESULTS: 24 males (52.2%) and 22 females (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). 31 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<.01). Small AVM size (p<.01; OR .12; 95% CI .02, .59) and exclusive deep venous drainage (p<.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 (GCS) on admittance (p<.05; OR .148; 95% CI .03, .73;).CONCLUSION: Two-thirds of children with AVM are admitted with intracerebral hemorrhage. Microsurgical resection was successful as confirmed by radiological studies in 95% and 79.5% of patients presented in a good clinical condition on follow-up (mRS 0 or 1). Microsurgical treatment is recommended if the lesion is accessible and angioarchitectural risk factors favor definitive treatment.
U2 - 10.1016/j.wneu.2016.02.050
DO - 10.1016/j.wneu.2016.02.050
M3 - SCORING: Journal article
C2 - 26898497
VL - 89
SP - 540
EP - 551
JO - WORLD NEUROSURG
JF - WORLD NEUROSURG
SN - 1878-8750
ER -