Pediatric patients with poor neurological status and arteriovenous malformation hemorrhage: an outcome analysis

Abstract

<jats:sec> <jats:title>Object</jats:title> <jats:p>In general, patients who present with low Glasgow Coma Scale (GCS) scores and/or fixed and dilated pupils are not expected to do well following arteriovenous malformation (AVM) hemorrhage. However, there is a sense among neurosurgeons that pediatric patients may make a better recovery than adults following such an event. There have been few studies focusing on the outcome of pediatric patients with poor neurological status following AVM hemorrhage. The purpose of this study was to characterize functional outcome in pediatric patients with severe disability after AVM hemorrhage.</jats:p></jats:sec> <jats:sec> <jats:title>Methods</jats:title> <jats:p>This was a retrospective analysis of clinical presentation and outcome in 15 patients seen at the authors' pediatric hospital presenting with low GCS scores (defined as GCS ≤ 8) following AVM hemorrhage.</jats:p></jats:sec> <jats:sec> <jats:title>Results</jats:title> <jats:p>Initial GCS scores ranged from 3 to 6, and 11 of 14 patients had fixed pupils on clinical examination (data were not available in 1 patient). Eight of 15 patients suffered primarily a lobar hemorrhage, 3 suffered primarily infratentorial bleeding, 2 suffered primarily hemorrhages of the basal ganglia, and 2 suffered intraventricular hemorrhage. The overall mortality rate was 20% (3 of 15 patients). The clinical outcome of survivors was defined by the Pediatric Cerebral Performance Category (PCPC) and Pediatric Overall Performance Category (POPC) scores at follow-up. One year after AVM hemorrhage, 7 (58%) of the 12 surviving patients showed normal or mild disability (PCPC Score 1 or 2), whereas 5 (42%) of 12 patients had moderate or severe disability (PCPC Score 3 or 4). No patients were in a coma or vegetative state, and 11 (92%) of the 12 patients were functioning independently (POPC Score 1, 2, or 3) 1 year after AVM hemorrhage. All patients were functionally independent by last follow-up, with 8 patients (67%) in the normal or mild disability PCPC category, and 4 in the moderate category (PCPC Score 3). All 12 survivors made a meaningful recovery and went on to live independent lives.</jats:p></jats:sec> <jats:sec> <jats:title>Conclusions</jats:title> <jats:p>Pediatric patients suffering AVM hemorrhage have a good outcome and are able to function independently, despite a poor neurological state initially.</jats:p></jats:sec>

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

“…However, early surgery was prone to residual lesions due to incomplete preoperative examination and poor intraoperative visual field exposure, the intraoperative DSA in the Hybrid Angio-Surgical suite was recommended to verify complete eradication of the lesion [30]. In addition, the long-term outcomes between these two groups were similar, a contributing factor was probably children's better neural plasticity [31]. Thus, early surgical intervention was recommended for pediatric hemorrhagic AVMs after the initial hemorrhage in this cohort.…”

“…Considering the long potential life span and good neurological plasticity of children [31], the goal of treatment in the pediatric hemorrhagic AVMs must be complete obliteration. Kiri et al reported an obliteration rate of 89% in pediatric patients with low-grade AVMs after microsurgical resection [18].…”

Toward a comprehensive assessment of functional outcomes in pediatric patients with brain arteriovenous malformations: the Pediatric Quality of Life Inventory

“…2,16 Interestingly, pediatric patients seem to demonstrate superior outcomes in comparison with adult patients with similar lesions and presentations, although the mechanism underlying these superior outcomes is largely understudied and remains unknown. 21,23 It is important to precisely measure and accurately categorize disability associated with bAVM presentation and treatment to offer families prognosis and informed hopes for neurological recovery. Most series of pediatric bAVM clinical outcomes use the modified Rankin Scale (mRS) to measure disability, despite a lack of validation in pediatric patients.…”

Hemorrhagic Stroke: Clinical, Etiologic and Evolutive Aspects in Senegalese Children

“…Headache and vomiting are reported in 58-76% of patients and hemiplegia in 16.2 to 62% of patients [4,5,10,[11][12][13]. These clinical signs often reflect the location of the hemorrhage which is supratentorial at 73.4 to 92.85% of reported cases [4,8,14] and in 84.61% of children in our series. These are cerebral vascular malformations, first and foremost the arteriovenous malformations, which are the main causes of HS in children, in a proportion of 42.8 to 46% of cases [9,10].…”