Purpose We performed this study to investigate the potential predictors of long-term outcome in endovascular management of intracranial arteriovenous malformations (AVMs) with/without surgical resection in the pediatric population.
Materials and methods Consecutive pediatric patients (<18 years) presenting with intracranial AVMs verified by CT/MR/DSA imaging studies were enrolled in the study. Baseline demographics, presenting symptoms, angioarchitecture characteristics [location, compact/diffuse nidus type, maximum nidus diameter, superficial/deep drainage, associated flow-induced aneurysm and/or venous varix/stenosis/ectasia, number of arterial feeders/draining veins, Spetzler-Martin Grading (SMG) scores, and ruptured/unruptured lesions], treatment strategy (endovascular embolization and/or surgical resection versus conservative management), procedural complication, recurrence, and long-term functional outcome were obtained. Ninety days modified Rankin Scale score of ≤2 and achieving developmental milestones were used to determine good functional outcome as appropriate. Independent samples T test, chi square, and logistic regression analyzes were performed for statistical analyzes.
Results Fifty-eight cases (m/f: 38/20; mean age [(range)±SD: 10.99 (0.5–17) ±4.09 years] presented with 29 ruptured versus 29 unruptured AVMs. Presenting symptoms included severe headaches (35.8%), occasional mild-moderate headache (22.6%), incidental finding (22.6%), seizure (9.4%), focal neurological deficits (15.1%), and loss of consciousness 20.8%), respectively. Single or multi-session endovascular embolization was performed either alone or prior to surgical resection while three cases were managed conservatively. Procedural complication and lesion recurrence were encountered in 6.9% and 5.2% of cases, respectively. Good functional outcome was achieved in 49 (84%) of cases. Angioarchitecture features of the lesions are presented in the table. No significant association was observed between SMG and final outcome (P = 0.80). Regression analysis of clinical presentation, lesion characteristics, and treatment-related variables revealed that rupture and severe onset of headache were independent predictors of poor long-term functional outcome (P = 0.006, OR:3.5). Seven out of nine cases with poor clinical outcome presented with ruptured AVMs with unfavorable preprocedural mRS score in eight of them.
Conclusions In our study, size, eloquent location, and complex angioarchitecture of intracranial AVMs were not predictors of outcome while presentation and ruptured/unruptured status of the lesions were significant predictors of long-term clinical outcome in treatment strategy with endovascular approach.
Disclosures A. Honarmand: None. S. Ansari: None. M. Hurley: None. P. Golnari: None. M. Potts: None. B. Jahromi: None. A. Shaibani: None.
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