Influence of Patient Age on Angioarchitecture of Brain Arteriovenous Malformations

Abstract

Background and Purpose To determine if clinical and angioarchitectural features of brain AVMs differ between children and adults. Materials and Methods A prospectively collected institutional database of all patients diagnosed with brain AVMs since 2001 was queried. Demographic, clinical, and angioarchitecture information was summarized and analyzed with univariable and multivariable models. Results Results often differed when age was treated as a continuous variable as opposed to dividing subjects into children (≤18 years; n=203) versus adults (>18 years; n=630). Children were more likely to present with AVM hemorrhage than adults (59% vs. 41%, p<0.001). Although AVMs with a larger nidus presented at younger ages (mean of 26.8 years for >6 cm compared to 37.1 years for <3 cm), this was not significantly different between children and adults (p=0.069). Exclusively deep venous drainage was more common in younger subjects both when age was treated continuously (p=0.04), or dichotomized (p<0.001). Venous ectasia was more common with increasing age (mean, 39.4 years with ectasia compared to 31.1 years without ectasia) and when adults were compared to children (52% vs. 35%, p<0.001). Patients with feeding artery aneurysms presented at later average age (44.1 years) than those without such aneurysms (31.6 years); this observation persisted when comparing children to adults (13% vs. 29%, p<0.001). Conclusion Although children with brain AVMs were more likely to come to clinical attention due to hemorrhage than adults, venous ectasia and feeding artery aneurysms were underrepresented in children, suggesting that these particular high risk features take time to develop.

Periventricular Location as a Risk Factor for Hemorrhage and Severe Clinical Presentation in Pediatric Patients with Untreated Brain Arteriovenous Malformations

“…25 The role of exclusively deep venous drainage should be analyzed in further studies with larger sample sizes by using standard angiographic methods, because only 9.3% of children with BAVMs had exclusively deep venous drainage in our study, which is much less than the 17%-28% rate reported in other studies. 7 The presence of an associated aneurysm and deep nidus location has failed to correlate with BAVM hemorrhage in all previous pediatric studies, and our data corroborate these findings.…”

“…[8][9][10][11][12][13] A recent angiographic study revealed that the angioarchitectural features of BAVM, some of which confer a higher risk for future hemorrhage in adults, differ between children and adults. 7 However, only a few studies have specifically been conducted to assess the risk of pediatric BAVM hemorrhage and provide a prognosis before treatment (On-line Table 3). …”

“…7 Previous studies have been performed primarily in adults or patients of all ages and have shown that presentation with hem-orrhage is the most important and widely accepted risk factor for future bleeding from BAVMs. [8][9][10] Meta-analyses of natural history studies and large-scale cohort studies failed to reach a consensus regarding the role of other factors such as nidus size, exclusive deep venous drainage, associated arterial aneurysm, and deep location.…”

Management of arteriovenous malformations in the elderly: a single-center case series and analysis of outcomes

“…They hypothesized that prolonged hemodynamic stress over time could potentiate bAVM rupture in the elderly population. 15 Our study represents one of the largest cohorts of elderly patients with intracranial bAVMs and features several important lessons. First, the most common mode of bAVM presentation in patients above the age of 65 years was ICH, underscoring the fact that the natural history of bAVMs in the elderly is not benign as once believed and warrants aggressive, multimodal treatment.…”

Aneurysms Associated with Brain Arteriovenous Malformations

“…8 Finally, the presence of venous ectasia has been found to be inversely related to the risk of hemorrhage, probably reflecting a protective adaptive mechanism that may become more prevalent in older patients. 24 In a landmark study of patients with unruptured AVMs seen at the Mayo Clinic between 1974 and 1985, the risk of hemorrhage among patients with a coexisting, originally unruptured AVM and IA was 7% at 1 year compared with 3% among those with an AVM alone. This higher risk of hemorrhage persisted at 5 years in patients with AVMs and IAs (7%/year) compared with patients with isolated AVMs (1.7%/year).…”