Brain Arteriovenous Malformation Recurrence After Apparent Microsurgical Cure: Increased Risk in Children Who Present...

Area of Science:

• Neurology
• Neurosurgery
• Vascular Medicine

Background:

• Brain arteriovenous malformations (AVMs) can recur even after successful surgical resection.
• Pediatric patients may have different recurrence risks compared to adults.
• Initial presentation with AVM rupture is a key factor in recurrence risk.

Purpose of the Study:

• To determine if children have a higher risk of brain AVM recurrence than adults.
• To assess if the risk of recurrence varies based on initial AVM rupture.
• To identify predictors of AVM recurrence in pediatric patients.

Main Methods:

• Retrospective study of 115 patients under 25 years old with brain AVMs.
• All patients underwent complete surgical resection confirmed by digital subtraction angiography (DSA).
• Delayed follow-up DSA was used to detect AVM recurrence after apparent initial cure.

Main Results:

• A total of 12 patients (10.4%) experienced AVM recurrence.
• All recurrences occurred in patients initially presenting with intracranial hemorrhage (ICH).
• The risk of recurrence decreased by 14% per year of age at initial surgery (HR=0.86, P=0.031).

Conclusions:

• Children presenting with ruptured brain AVMs have a high rate of recurrence.
• Intracranial hemorrhage at initial presentation is a significant predictor of recurrence.
• Post-surgical imaging follow-up is crucial for detecting recurrence and preventing re-rupture.