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Published on: October 20, 2017
Brain Arteriovenous Malformation Recurrence After Apparent Microsurgical Cure: Increased Risk in Children Who Present
Alexander Copelan1, Gerald Drocton1, M Travis Caton1
1Division of Neurointerventional Radiology, Department of Radiology and Biomedical Imaging (A.C., G.D., M.T.C., E.R.S., D.L.C., M.R.A., C.F.D., V.V.H., R.T.H., S.W.H.), University of California, San Francisco.
Insights
Children with brain arteriovenous malformations (AVMs) who experience rupture have a high recurrence rate after surgery. Age is a significant factor, with younger patients facing increased risk, necessitating vigilant follow-up imaging.
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.
Background And Purpose:
Do children have an increased risk for brain arteriovenous malformation (AVM) recurrence compared with adults and does this risk vary depending on initial presentation with AVM rupture?
Methods:
We retrospectively studied 115 patients initially presenting with brain AVM under age 25 years who underwent complete surgical resection of the AVM as documented by digital subtraction angiography (DSA) and had delayed follow-up DSA to evaluate for AVM recurrence after apparent initial cure.
Results:
The mean time from baseline DSA to follow-up DSA was 2.3 years, ranging from 0 to 15 years. Twelve patients (10.4% of the 115 patient cohort and 16.7% of 72 patients with hemorrhage at initial presentation) demonstrated AVM recurrence on follow-up DSA. All patients with recurrence initially presented with intracranial hemorrhage, and intracranial hemorrhage was a significant predictor of recurrence (log rank P=0.037). Among patients with initial hemorrhage, the 5-year recurrence rate was 17.8% (95% CI, 8.3%-35.7%). All recurrences occurred in patients who were children at the time of their initial presentation; the oldest was 15 years of age at the time of initial AVM surgery. The 5-year recurrence rate for children (0-18 years of age) with an initial presentation of hemorrhage was 21.4% (95% CI, 10.1%-41.9%). Using Cox regression, we found the risk of AVM recurrence decreased by 14% per each year increase in age at the time of initial surgical resection (hazard ratio=0.86 [95% CI, 0.75-0.99]; P=0.031).
Conclusions:
There is a high rate of recurrence of apparently cured brain AVMs in children who initially present with AVM rupture. Imaging follow-up is warranted to prevent re-rupture.
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