Ruptured Brain Arteriovenous Malformations in Children: Correlation of Clinical Outcome with Admission Parameters

Abstract

Aims: To gain a better understanding of how clinical outcome in children with ruptured brain arteriovenous malformations (bAVMs) correlates with clinical and imaging parameters on admission. Methods: The authors retrospectively reviewed patients with bAVMs, aged 18 or below, managed at their hospital between January 1992 and December 2008. Clinical outcome was assessed using the modified Rankin Scale (mRS). Patients with ruptured bAVMs were analyzed; their clinical parameters and computerized tomography findings on admission were recorded. Clinical outcome was then evaluated against admission scores using the Glasgow Coma Scale (GCS), the World Federation of Neurosurgical Societies Grading System of Subarachnoid Hemorrhage (WFNS-SAH), the Spetzler-Martin grade, the intracerebral hemorrhage score and 2 other independent parameters, namely pupillary response and significant focal neurological injuries. Spearman’s correlation coefficient, linear regression analysis and multivariate logistic regression analysis were used for data analysis. Results: 40 pediatric patients with bAVMs were found and 32 of them presented with hemorrhage (80%). In the 32 children with ruptured bAVMS, follow-up ranged between 7 and 204 months (median 100.5 months). The complete excision/obliteration rate as confirmed by digital subtraction angiography was 73.3%. The mRS scores at the last follow-up were: grades 0–II in 87.5%; grades IV–V in 6.25%, and grade VI in 6.25%. The Spetzler-Martin grade, the intracerebral hemorrhage score, the WFNS-SAH grade, the GCS scores, and a combined scoring scale consisting of the GCS, pupillary response and significant focal neurological injuries correlated significantly with clinical outcome 6 months after hemorrhage. However, on the scatter diagrams, it appeared that only the combined scoring scale might be valid for clinical practice. Multivariate logistic regression analysis showed that the combined scoring scale was a statistically significant independent predictor of clinical outcome 6 months after hemorrhage. Conclusion: In this series of pediatric patients with ruptured bAVMs, although various grading scales correlated significantly with clinical outcome 6 months after hemorrhage, only the combined scoring scale might have the potential to be applied to predict clinical outcome in these children.

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

“…Although this study has quite impressive follow-up (mean 9.2 years), there was a remarkably high complication rate with treatment of highgrade (Grade IV and V) AVMs (28% compared with 5% in low-grade lesions), although this was accounted for in multivariate modeling. Wong et al 28 analyzed mRS clinical outcomes at 6 months and "most recently" in a series of 40 treated pediatric bAVMs. They found Spetzler-Martin grade, intracerebral hemorrhage score, WFNS SAH grade, and GCS scores all to be predictive of clinical outcome (mRS score) at 6 months.…”

The factors associated with hemorrhagic presentation in children with untreated brain arteriovenous malformation: a meta-analysis

“…Initial research identified 70 eligible articles and included 15 articles 1,2,11,16,17,20,35,46,47,51,53,59,62,66,76 that described any factors associated with hemorrhagic presentation, after excluding 55 articles for the following reasons: no data for calculating the risk of variables for hemorrhagic presentation, 22,44,58,63,64,75,79,83 inclusion of the same cohort as another report, 48,69 patients with AVMs treated before hemorrhage, 14,49,51,55,74 inclusion of only specific cases (such as patients with hereditary hemorrhagic telangiectasia, 78 cerebellar AVM, 25 Gamma Knife surgery, 4,6-8, 13, 15, 24, 27, 34, 38, 40, 54, 57, 60, 70,80-82 embolization, 12,67 or microsurgery 18,23,26,43 treatment), impossibility of separating pediatric patients from adult patients, 10,28,33,41,45,77 less than 20 cases included,…”

Pre-Adult MRI of Brain Cancer and Neurological Injury: Multivariate Analyses

“…Figure 2 illustrates two preterm infants born at 29 weeks gestational age (GA) with small CBHs ( 61 ). Wong and Fong ( 62 ) investigated children with ruptured brain arteriovenous malformations and employed multivariate analyses which demonstrated that a scoring scale that combined the Glasgow Coma Score, pupillary response and significant focal neurological injuries was a statistically significant independent predictor of clinical outcomes 6 months after hemorrhage.…”