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Pediatric intracranial arteriovenous malformations: Examining rehabilitation outcomes
Melissa A LoPresti1, Nisha Giridharan1, Monika Pyarali1
1Division of Pediatric Neurosurgery, Texas Children's Hospital, Department of Neurosurgery, Baylor College of Medicine, Houston, TX, USA.
Insights
Pediatric arteriovenous malformation (AVM) patients showed significant functional gains in self-care, mobility, and cognition after inpatient rehabilitation. All treatment approaches led to improved outcomes, highlighting rehabilitation
Area of Science:
- Neurology
- Pediatric Rehabilitation
- Neurosurgery
Background:
- Arteriovenous malformations (AVMs) in children can lead to severe neurological deficits.
- Limited literature exists on the rehabilitation outcomes for pediatric AVM patients.
- Rehabilitation is crucial for recovery following AVM-related neurological injury.
Purpose of the Study:
- To examine the acute inpatient rehabilitation outcomes for pediatric patients with intracranial arteriovenous malformations (AVMs).
- To assess functional improvements across various treatment modalities for pediatric AVMs.
Main Methods:
- Retrospective chart review of patients aged 18 and younger treated between 2012-2018.
- Analysis of patient characteristics, clinical data, treatment, and functional outcomes.
- Utilized Functional Independence Measure for Children (WeeFIM®) scores to measure progress.
Main Results:
- 14 pediatric patients with intracranial AVMs completed acute inpatient rehabilitation.
- Patients demonstrated improvement in self-care, mobility, and cognition upon discharge.
- Mean total WeeFIM® score changes were 36.7 (surgical), 16.5 (non-surgical), and 25.7 (prior surgical).
Conclusions:
- All pediatric patients with intracranial AVMs showed functional improvements after inpatient rehabilitation.
- Outcomes improved across all functional domains regardless of treatment modality.
- Acute inpatient rehabilitation is effective for pediatric AVM patients.
Purpose:
Arteriovenous malformation (AVM) rupture in children can cause debilitating neurological injury. Rehabilitation is key to recovery, though literature details little regarding rehabilitation outcomes. We examined a single-center experience with pediatric AVMs as related to acute inpatient rehabilitation outcomes.
Methods:
At our institution, a retrospective chart review was completed examining all cases of intracranial AVMs in patients age 18 and younger who completed our acute inpatient rehabilitation program between 2012-2018. Patient characteristics, clinical data, treatment modality, and functional outcomes were reviewed.
Results:
14 patients with AVMs underwent acute inpatient rehabilitation; nine (64.3%) treated surgically at our institution, two (14.3%) non-surgically at our institution, and three (21.4%) surgically at an outside facility prior to transitioning care at our institution. Eight (57.1%) were male, seven (50.0%) Caucasian, and seven (50.0%) Hispanic. Seven (50.0%) presented with AVM rupture; six (42.9%) were found incidentally on imaging. Clinical courses, treatment outcomes, and post-treatment complications varied. Several patients underwent repeat treatment or additional procedures. Neurological deficits identified included hemiparesis, dystonia, spasticity, epilepsy, hydrocephalus, and ataxia. Inpatient rehabilitation unit length of stay was on average 21 days (SD 9.02, range 9-41). Functional Independence Measure for Children (WeeFIM®) scores, including self-care, mobility, and cognition, demonstrated improvement upon discharge. The mean total change was 36.7 points in those treated surgically, 16.5 in those treated non-surgically, and 25.7 in those treated surgically at another facility.
Conclusion:
We found that all pediatric patients with intracranial AVMs, across all treatment modalities, demonstrated improved outcomes across all functional domains after an acute inpatient rehabilitation program.
