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Comprehensive Endovascular and Open Surgical Management of Cerebral Arteriovenous Malformations
Published on: October 20, 2017
Pediatric patients with poor neurological status and arteriovenous malformation hemorrhage: an outcome analysis
Ash Singhal1, Tara Adirim, Doug Cochrane
1Division of Neurosurgery, Department of Surgery, University of British Columbia and British Columbia Children's Hospital, Vancouver, British Columbia, Canada. ash.singhal@cw.bc.ca
Insights
Pediatric patients with severe neurological deficits after arteriovenous malformation (AVM) hemorrhage show remarkable recovery. Most survivors achieve functional independence and normal or mild disability within a year.
Area of Science:
- Neurology
- Pediatric Neurosurgery
- Neurovascular Diseases
Background:
- Arteriovenous malformation (AVM) hemorrhage typically results in poor outcomes for patients with low Glasgow Coma Scale (GCS) scores.
- Pediatric patients with AVM hemorrhage and severe neurological deficits may exhibit better recovery than adults.
- Limited research exists on the functional outcomes of pediatric patients with poor neurological status post-AVM hemorrhage.
Purpose of the Study:
- To characterize the functional outcomes of pediatric patients experiencing severe disability after AVM hemorrhage.
- To assess the recovery potential in children with initially low GCS scores following AVM rupture.
Main Methods:
- Retrospective analysis of 15 pediatric patients with GCS scores ≤ 8 following AVM hemorrhage.
- Evaluation of clinical presentation, including pupil status and hemorrhage location.
- Assessment of functional outcomes using Pediatric Cerebral Performance Category (PCPC) and Pediatric Overall Performance Category (POPC) scores at follow-up.
Main Results:
- Initial GCS scores ranged from 3 to 6, with 11 of 14 patients exhibiting fixed pupils.
- Mortality rate was 20% (3 of 15 patients).
- Among 12 survivors, 58% had normal or mild disability (PCPC 1-2) and 92% were functioning independently (POPC 1-3) at 1 year. All survivors achieved functional independence by last follow-up.
Conclusions:
- Pediatric patients with AVM hemorrhage and initially severe neurological impairment demonstrate a strong capacity for recovery.
- Despite poor initial neurological status, pediatric survivors of AVM hemorrhage can achieve independent functional outcomes.
- This study highlights the favorable prognosis for pediatric patients following AVM hemorrhage, even with critical initial presentations.
Object:
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.
Methods:
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.
Results:
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.
Conclusions:
Pediatric patients suffering AVM hemorrhage have a good outcome and are able to function independently, despite a poor neurological state initially.
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