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Updated: Dec 29, 2025
Comprehensive Endovascular and Open Surgical Management of Cerebral Arteriovenous Malformations
Published on: October 20, 2017
Long-term functional outcome after intervention for pediatric intracranial arteriovenous malformations: A systematic
Victor M Lu1, Waseem Wahood1, Lorenzo Rinaldo1
1Department of Neurosurgery, Mayo Clinic, Rochester, MN, United States.
Insights
Interventions for pediatric arteriovenous malformations (pAVMs) lead to favorable long-term outcomes, persisting for years. The risk of long-term functional deficit should not solely guide treatment decisions.
Area of Science:
- Pediatric Neurosurgery
- Interventional Neuroradiology
- Neurology
Background:
- Pediatric arteriovenous malformations (pAVMs) require intervention for optimal outcomes.
- While short-term results are known, long-term functional outcomes after pAVM intervention need thorough consolidation.
Purpose of the Study:
- To consolidate and analyze the long-term functional outcomes of pediatric arteriovenous malformation (pAVM) patients following intervention.
- To evaluate the impact of presentation (hemorrhagic vs. non-hemorrhagic) and intervention modality on long-term outcomes.
Main Methods:
- Systematic literature search of 7 electronic databases (inception to April 2019) following PRISMA guidelines.
- Screening of articles based on pre-specified criteria.
- Random-effects meta-analysis of proportions to pool data from 14 studies involving 699 pAVM patients.
Main Results:
- A favorable functional outcome (modified Rankin Scale 0-2) was estimated in 87% of patients at a median follow-up of 4.1 years.
- No statistically significant difference in favorable outcomes was observed between hemorrhagic (78%) and non-hemorrhagic (91%) presentations.
- Intervention modalities included surgery, embolization, and radiosurgery.
Conclusions:
- Favorable long-term functional outcomes in pAVM patients following intervention are durable and can persist for many years.
- The certainty of achieving favorable outcomes is moderate, independent of presentation type or intervention method.
- Long-term functional deficit risk alone should not be the sole determinant for pursuing pAVM intervention.
Abstract:
Intervention (surgery, embolization, and radiosurgery) is critical in maximizing outcomes of pediatric arteriovenous malformations (pAVMs). Although short-term functional outcomes following intervention have been stablished to be favorable, long-term outcomes have yet to be thoroughly consolidated. Searches of 7 electronic databases from inception to April 2019 were conducted following PRISMA guidelines. Articles were screened against pre-specified criteria. Favorable functional were modified Rankin Scale (mRS) scores ranging from 0 to 2, and the incidences were extracted and pooled by random-effects meta-analysis of proportions. Fourteen pertinent studies were identified describing outcomes of 699 pAVM patients, with median 75 % presenting with hemorrhage. Surgery, embolization and radiosurgery use were reported by 12 (86 %), 14 (100 %) and 10 (71 %) studies respectively. By median study follow-up time of 4.1 years, a favorable functional outcome was estimated to occur in 87 % (95 % CI, 82-91 %) of subjects respectively. Hemorrhagic versus non-hemorrhagic presentations did not statistically differ in incidence of this long-term outcome, 78 % (95 % CI, 67-87 %) and 91 % (95 % CI, 80-98 %) respectively. This study demonstrates that favorable long-term functional outlook of pAVM subjects after intervention can persist for many years after initial intervention. The certainty of achieving this outcome is moderate, irrespective of hemorrhagic presentation or intervention modality. Long-term functional deficit risk should not be the sole factor in deciding if intervention should be pursued.
