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Comprehensive Endovascular and Open Surgical Management of Cerebral Arteriovenous Malformations
Published on: October 20, 2017
Predictive Factors of Postoperative Seizure for Pediatric Patients with Unruptured Arteriovenous Malformations
Haibo Yang1, Zhenghai Deng2, Wuyang Yang3
1Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, People's Republic of China; China National Clinical Research Center for Neurological Diseases, Beijing, People's Republic of China; Center of Stroke, Beijing Institute for Brain Disorders, Beijing, People's Republic of China; Beijing Key Laboratory of Translational Medicine for Cerebrovascular Diseases, Beijing, People's Republic of China; Department of Pediatric Surgery, Peking University First Hospital, Peking University, Beijing, People's Republic of China.
Insights
Surgery for pediatric arteriovenous malformations (AVMs) can eliminate seizures, with large AVM size and temporal location predicting postoperative seizures. Careful patient selection is key for successful surgical outcomes in pediatric AVM patients.
Area of Science:
- Pediatric Neurosurgery
- Neurology
- Vascular Malformations
Background:
- Seizures are a common complication in pediatric patients with arteriovenous malformations (AVMs).
- The risk of postoperative seizures in pediatric unruptured AVMs is not well-documented.
- This study addresses the need for better understanding of postoperative seizure risk and its predictors.
Purpose of the Study:
- To characterize postoperative seizure risk in pediatric patients undergoing surgery for unruptured AVMs.
- To identify factors that predict the occurrence of seizures after surgery for pediatric AVMs.
Main Methods:
- Retrospective review of surgically treated pediatric patients with unruptured AVMs (2001-2014).
- Comparison of baseline variables to identify patients with and without follow-up seizures.
- Multivariable Cox regression analysis to determine predictive factors for postoperative seizures.
Main Results:
- 18.2% of patients experienced postoperative seizures during a 4.2-year follow-up.
- Larger AVM size (HR 1.63) and temporal location (HR 8.35) significantly increased the risk of follow-up seizures.
- Seizure presentation and postoperative infection were not associated with increased seizure risk.
Conclusions:
- Surgery can effectively eliminate seizures in most pediatric patients with unruptured AVMs.
- Large AVM size and temporal location are key predictors of postoperative seizures.
- Surgery is a reasonable primary treatment for selected pediatric unruptured AVMs, particularly those that are small and in non-temporal locations.
Background:
Seizure is the second-most common presentation in patients with arteriovenous malformations (AVMs) and superimposes a significant burden on pediatric patients. Postoperative seizure risk in unruptured AVMs is underreported in the pediatric AVM literature. We aimed to characterize and identify predictive factors for postoperative seizures in this study.
Methods:
We performed a retrospective review of all surgically treated pediatric patients with unruptured AVM at our institution from 2001 to 2014. Patients younger than 18 years of age were included. Baseline variables was compared against our outcome of interest, which was defined as patients with or without follow-up seizures. Multivariable Cox regression was performed to identify potential predictive factors.
Results:
The average age of all patients was 13.1 years, and 68.2% were male. Nine patients were asymptomatic (13.6%), and seizure presentation occurred in 57.6% (n = 38). During an average follow-up of 4.2 years, 12 (18.2%) patients experienced postoperative seizures, with 5 (17.9%) of 28 patients with seizures being de novo. In patients with seizure presentation, 81.6% were completely seizure-free throughout follow-up. In multivariable analysis, larger AVM size (hazard ratio [HR] 1.63, P = 0.023) and temporal location (HR 8.35, P = 0.007) were found to increase the risk of follow-up seizures. On the contrary, seizure presentation (HR 1.91, P = 0.369) and postoperative infection (HR 2.37, P = 0.265) were not associated.
Conclusions:
Surgery may eliminate most seizures with low risk of inducing de novo seizures in pediatric patients with unruptured AVM. Predictive factors for postoperative seizures included large AVM size and temporal location. For selected unruptured AVMs with small size and nontemporal location, consideration of surgery as primary treatment for persistent seizures is a reasonable option.
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