Related Experiment Video
Updated: Mar 31, 2026
Comprehensive Endovascular and Open Surgical Management of Cerebral Arteriovenous Malformations
Published on: October 20, 2017
Outcomes of Multimodality Therapy in Pediatric Patients With Ruptured and Unruptured Brain Arteriovenous
John D Nerva1, Louis J Kim, Jason Barber
1Departments of *Neurological Surgery,‡Radiology, and§Radiation Oncology, University of Washington, Seattle, Washington.
Insights
Pediatric brain arteriovenous malformations (BAVMs) treated with surgery or radiosurgery show high cure rates and good functional outcomes. Early-grade BAVMs have superior results, while higher grades require further management strategies.
Area of Science:
- Neuroscience
- Pediatric Neurology
- Neurosurgery
Background:
- Brain arteriovenous malformations (BAVMs) are a significant cause of stroke in children, leading to severe disability and death.
- Multimodality treatment is employed for both ruptured and unruptured BAVMs.
Observation:
- A retrospective review of 40 pediatric patients (<18 years) with BAVMs treated with surgery or stereotactic radiosurgery.
- Patients were stratified by hemorrhage status (ruptured vs. unruptured) and treatment modality.
Findings:
- Most ruptured BAVMs (27 patients) achieved radiographic cure (92%) and good functional outcomes (mRS 0-2 in 88% of survivors).
- Unruptured BAVMs grades I-III had excellent outcomes (radiographic cure, mRS 0-1).
- Unruptured BAVMs grades IV-V showed lower obliteration rates and slightly worse functional scores.
Implications:
- Multimodality treatment offers favorable outcomes for pediatric BAVMs, particularly for ruptured cases and lower-grade unruptured BAVMs.
- Optimal management strategies for high-grade unruptured BAVMs require further investigation.
- The study highlights the safety and efficacy of current treatment paradigms for pediatric BAVMs.
Background:
Brain arteriovenous malformations (BAVMs) are a frequent cause of pediatric hemorrhagic stroke, which frequently results in significant morbidity and mortality.
Objective:
To analyze the results of multimodality treatment for a consecutive series of pediatric patients with ruptured and unruptured BAVMs at a single institution.
Methods:
Forty patients <18 years of age were retrospectively reviewed. Results were divided by hemorrhage status, ie, ruptured or unruptured, and the intended curative treatment modality, ie, surgical resection or stereotactic radiosurgery.
Results:
Twenty-seven patients (68%) presented with hemorrhage, and 13 patients (32%) presented without hemorrhage. Among ruptured patients, 19 (70%) underwent surgery and 8 (30%) underwent stereotactic radiosurgery. In surviving patients who presented with hemorrhage, 23 of 26 (88%) had a modified Rankin Scale (mRS) score of 0 to 2 at the last follow-up, and 24 of 26 (92%) obtained radiographic cure. For unruptured BAVMs, all 6 patients with grade I to III BAVM obtained radiographic cure and had an mRS score of 0 to 1 at the last follow-up, whereas 1 of 5 patients (20%) with grade IV and V BAVM had BAVM obliteration and a mean mRS score of 1.8 at the last follow-up. In a total of 93.6 years of follow-up from date of presentation to last clinical follow-up, there was 1 hemorrhage (1.1%/y). Of 30 patients with radiographic obliteration, 2 patients had radiographic recurrence (7% incidence).
Conclusion:
The majority of ruptured patients had an mRS score of 0 to 2 at the last follow-up and obtained radiographic cure. Unruptured patients with grade I to III BAVMs had superior outcomes compared with those with grade IV and V AVMs. Treatment of grade I to III BAVMs appears safe, and additional study is needed to determine optimal strategies for the management of unruptured grade IV and V BAVMs.
Related Concept Videos
01:22Aneurysm IV: Nursing Management
01:26Aneurysm III: Interprofessional Care
01:21Aneurysm II: Clinical Manifestations and Diagnostic Studies