Risk Factors for Early Brain AVM Rupture: Cohort Study of Pediatric and Adult Patients.

Area of Science:

• Neurology
• Radiology
• Neurosurgery

Background:

• Brain arteriovenous malformations (AVMs) are complex vascular lesions.
• The angioarchitecture of ruptured brain AVMs and its variation across the lifespan is not well understood.
• Identifying features associated with early-life rupture is crucial for risk stratification.

Purpose of the Study:

• To investigate angioarchitectural differences in ruptured brain AVMs between pediatric and adult populations.
• To identify specific features linked to earlier rupture in brain AVMs.

Main Methods:

• Retrospective analysis of 320 patients with ruptured brain AVMs from two academic centers (2000-2018).
• Review of imaging for angioarchitectural characteristics: nidus size, location, Spetzler-Martin grade, venous drainage, and aneurysms.
• Statistical analysis using uni- and multivariable, Kaplan-Meier, and Cox models to assess age-related variations and rupture predictors.

Main Results:

• Pediatric brain AVMs (n=122) were more frequently deep-seated (56.3%) and had larger nidi (24.2 mm) compared to adults (n=198).
• Pediatric AVMs showed fewer nidal (15.9%) and arterial aneurysms (2.7%) than adults.
• Deep AVM location and exclusive deep venous drainage were significantly associated with earlier rupture (P < .001).
• Arterial or nidal aneurysms were linked to later-life rupture.

Conclusions:

• Significant angioarchitectural variations exist in ruptured brain AVMs across the lifespan.
• Deep location and deep venous drainage are key features associated with early-life AVM rupture.
• These findings can inform treatment strategies for unruptured AVMs based on their angioarchitectural profile.