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

Xiaolin Ai1, Zengpanpan Ye1, Jianguo Xu1

  • 11Department of Neurosurgery and.

Journal of Neurosurgery. Pediatrics
|December 15, 2018
PubMed

Insights

Pediatric arteriovenous malformations (AVMs) with smaller size, deep venous drainage, single feeder/vein, deep/infratentorial location, or diffuse morphology show higher rupture risk. High Spetzler-Martin grade AVMs have lower rupture risk.

Area of Science:

  • Neurology
  • Neurosurgery
  • Pediatric Neurology

Background:

  • Pediatric arteriovenous malformations (AVMs) pose significant risks of mortality and disability due to rupture.
  • Treatment decisions require balancing rupture risk against potential iatrogenic injury.
  • Identifying predictors of hemorrhagic presentation is crucial for managing pediatric AVMs.

Purpose of the Study:

  • To conduct a meta-analysis evaluating predictors of hemorrhagic presentation in pediatric patients with untreated brain AVMs.
  • To synthesize existing evidence on factors influencing AVM rupture in children.

Main Methods:

  • Systematic literature search of PubMed and EMBASE databases.
  • Inclusion of studies reporting predictors of hemorrhagic presentation in pediatric brain AVMs.
  • Assessment of predictive ability using odds ratios (ORs) and 95% confidence intervals (CIs).

Main Results:

  • Smaller size (< 3 cm), deep venous drainage, single feeder, single draining vein, deep/infratentorial location, and diffuse morphology were associated with a higher risk of hemorrhage.
  • Diffuse AVM morphology demonstrated the highest odds ratio for hemorrhagic presentation.
  • Draining vein ectasia and high Spetzler-Martin (SM) grade were associated with a lower risk of hemorrhage.

Conclusions:

  • Key predictors for hemorrhagic presentation in pediatric AVMs include smaller size, deep venous drainage, single feeder/vein, deep/infratentorial location, and diffuse morphology.
  • Diffuse AVMs represent a particularly high-risk group requiring consideration for active treatment.
  • Factors like age, sex, draining vein stenosis, and associated aneurysms were not found to be significant predictors.

Keywords:
AVM = arteriovenous malformationCI = confidence intervalNOS = Newcastle-Ottawa ScaleOR = odds ratioSM = Spetzler-Martinarteriovenous malformationhemorrhagic presentationpediatricvascular disorders

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