Long-term outcomes and prognostic predictors of 111 pediatric hemorrhagic cerebral arteriovenous malformations after microsurgical resection: a single-center experience

Abstract

Comparison in pediatric hemorrhagic arteriovenous malformations (AVMs) to clarify the long-term neurological outcomes and prognostic predictors after surgical intervention was relatively rare, especially in the selection of surgical timing. The objective of this study was to elucidate these points. The authors retrospectively reviewed the pediatric hemorrhagic AVMs resected in their neurosurgical department between March 2010 and June 2017. The natural history was represented by rupture risk. Neurological outcome was assessed with the modified Rankin Scale (mRS) for children. Multivariate logistic regression analyses were used to assess the risk factors for disability (mRS > 2). The hemorrhagic early phase was defined as less than 30 days after bleeding. The corresponding prognosis of different surgical timing (early intervention or delayed intervention) was compared after propensityscore matching (PSM). A total of 111 pediatric hemorrhagic AVM patients were evaluated. The average patient age was 11.1 ± 4.0 years, with a mean follow-up of 4.3 ± 2.1 years. The annualized rupture risk was 9.3% for the pediatric hemorrhagic AVMs, and the annualized re-rupture risk was 9.8%. 7.2% of the patients had disabilities (mRS > 2) and 82.0% achieved neurological deficit-free (mRS < 2) at the last follow-up. Pre-treatment mRS (P = 0.042) and flow-related aneurysms (P = 0.039) were independent factors for long-term disability. In terms of short-term outcomes, early intervention was better than delayed intervention (P = 0.033), but the long-term outcomes were similar between the two groups (P = 0.367). Surgical intervention for pediatric hemorrhagic AVMs is recommended, most of the patients can achieve good neurological outcomes. Moreover, early surgical intervention is preferred after the initial hemorrhage.

Ruptured Brain Arteriovenous Malformations: Surgical Timing and Outcomes—A Retrospective Study of 25 Cases

“…Our analysis also showed that patients under 40 years of age with poor neurological status at the entrance, average ICH score of 2.67 ± 0.62, and low AVM surgical risk, undergoing early resection of the lesion, had a 3-month poor average mRS (2.47 ± 0.71), while at 1 year the outcome was very favorable (1 ± 0.4). This suggests, in line with other studies, 9,18,25 how in young patients with a high ICH score at the entrance, one or more risk factors consistently related to poor outcome (low GCS, volume clot > 30 mL, infratentorial hemorrhage), and a low-grade Spetzler-Martin malformation, early intervention of evacuation and AVM removal in one single surgical time represents a valid and feasible therapeutic strategy. In a study released in 2020, Deng et al reported a single-center study on 111 hemorrhagic bAVMs in children suggesting that early surgical treatment is preferable following the hemorrhagic presentation.…”

“…In a study released in 2020, Deng et al reported a single-center study on 111 hemorrhagic bAVMs in children suggesting that early surgical treatment is preferable following the hemorrhagic presentation. 25 Aboukaïs et al 26 found that in grade I bAVMs long-term morbidity is, in the majority of cases, related to the brain damage determined by the hemorrhagic event; only in few cases, this may be linked to AVM resection.…”

Contemporary management of brain arteriovenous malformations in mainland China: a web-based nationwide questionnaire survey

“…Martinez et al recommended a delayed intervention for at least 4 weeks after the initial hemorrhage. In contrast, Deng et al proposed that short-term outcomes of the early intervention were better, though the long-term outcomes were similar [31]. In this study, most of the neurosurgeons and neurointerventionists recommended early intervention (< 30 days) for ruptured bAVMs; however, the radiosurgeons suggested intervention in the chronic phase or recovery phase and preferably 3 months after bleeding.…”

Contemporary management of brain arteriovenous malformations in mainland China: a web-based nationwide questionnaire survey

“…In contrast, Deng et al. proposed that short-term outcomes of the early intervention were better, though the long-term outcomes were similar (31). In this study, most of the neurosurgeons and neurointerventionists recommended early intervention (<30 days) for ruptured bAVMs, however, the radiosurgeons suggested intervention in the chronic phase or recovery phase, and preferably 3 months after bleeding.…”