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Pediatric brain arteriovenous malformation unfavorable hemorrhage risk: extrapolation to a morphologic model
Zongze Li1,2, Li Ma1,2,3, Chunxue Wu4
1Department of Neurosurgery, Peking University International Hospital, Beijing, 102206 People's Republic of China.
Insights
A new classification system for pediatric brain arteriovenous malformations (bAVM) helps predict unfavorable hemorrhage. This model, based on nidus location and venous drainage, aids in early risk assessment for children with bAVM.
Area of Science:
- Neurology
- Pediatric Neurosurgery
- Vascular Malformations
Background:
- Children with brain arteriovenous malformations (bAVM) face significant risks of life-threatening hemorrhage.
- Hemorrhage in pediatric bAVM can lead to severe, early-onset neurological deficits.
Purpose of the Study:
- To develop and validate a classification system for predicting unfavorable hemorrhage in pediatric brain arteriovenous malformations.
- To identify key morphological features associated with hemorrhage risk in pediatric bAVM.
Main Methods:
- Retrospective analysis of 162 pediatric bAVM cases admitted between July 2009 and August 2015.
- Definition of unfavorable hemorrhage as life-threatening or associated with mRS > 3.
- Univariate and multivariable regression analyses, discrimination analysis with AUROC and 5-fold cross-validation were employed.
Main Results:
- Unfavorable hemorrhage occurred in 30.2% of pediatric bAVM cases.
- Independent predictors of unfavorable hemorrhage included periventricular nidus location, non-temporal lobe location, and long pial draining vein.
- A three-type classification system (Type I, II, III) demonstrated a predictive accuracy (AUROC) of 0.77 for unfavorable hemorrhage.
Conclusions:
- A morphologic model incorporating nidus location and venous drainage characteristics can predict unfavorable hemorrhage in pediatric bAVM.
- This classification system offers a valuable tool for risk stratification and management planning in pediatric bAVM.
Background:
Children with brain arteriovenous malformations (bAVM) are at risk of life-threatening hemorrhage contributing to unfavorable neurological deficit in their early lives. Our aim was to propose a classification system predicting the unfavorable hemorrhage in children with bAVM.
Methods:
We identified all consecutive children admitted to our institution for bAVMs between July 2009 and August 2015. A hemorrhage event was defined as unfavorable when it is life-threatening (requiring emergent invasive intervention) or with post-hemorrhage mRS > 3. The effects of demographic characteristics and bAVM morphology on unfavorable hemorrhage risk were studied using univariate and multivariable regression analyses, followed by discrimination analysis using area under the receiver operating curve (AUROC) and 5-fold cross validation.
Results:
A total of 162 pediatric bAVM cases were identified, unfavorable hemorrhage occurred in 49 (30.2%). Periventricular nidus location (HR, 4.46; 95%CI, 1.93-10.31; P < 0.001), non-temporal lobe location (HR, 2.72; 95%CI, 1.20-6.15; P = 0.02) and long pial draining vein (HR, 3.26; 95%CI, 1.53-6.97; P = 0.002) were independent predictors of an earlier unfavorable hemorrhage in pediatric bAVMs. We further classified the bAVM into three types: Type I, periventricular and non-temporal location (Ia, deep location; Ib, superificial location); Type II, with long pial draining vein and non-periventricular or temporal location; Type III, non-periventricular or temporal location without long draining vein. Predictive accuracy of this classification for unfavorable hemorrhage was assessed with AUROC of 0.77 (95% CI 0.69-0.85) and remained stable after cross validation.
Conclusion:
A morphologic model based on nidus location and venous drainage might predict unfavorable hemorrhage in children with bAVM.
