Clinical Characteristics and Multimodality Therapy Outcomes in 304 Pediatric Patients with Cerebral Arteriovenous Malformations
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Updated: Aug 25, 2025
Comprehensive Endovascular and Open Surgical Management of Cerebral Arteriovenous Malformations
Published on: October 20, 2017
Haoyu Zhu1, Yupeng Zhang1, Shikai Liang2
1Department of Interventional Neuroradiology, Beijing Neurosurgical Institute, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.
Insights
Pediatric cerebral arteriovenous malformations (AVMs) often present with hemorrhage, particularly in deep brain areas. Nonconservative treatment may offer better outcomes for children with brain AVMs, reducing risks of re-hemorrhage.
Area of Science:
- Pediatric Neurology
- Neurosurgery
- Vascular Neurology
Background:
- Limited clinical follow-up data exists for pediatric cerebral arteriovenous malformations (AVMs).
- Understanding AVM characteristics and treatment outcomes in children is crucial for effective management.
Purpose of the Study:
- To investigate the specific characteristics of cerebral arteriovenous malformations (AVMs) in pediatric patients.
- To analyze the clinical outcomes of multimodality therapy for pediatric AVMs.
Main Methods:
- Retrospective study of 1009 AVM patients, with 304 pediatric cases (<18 years).
- Data collection included demographics, AVM features, and clinical outcomes.
- Multivariate regression and Kaplan-Meier analysis were used to identify outcome predictors.
Main Results:
- Pediatric AVMs were more frequently associated with intracranial hemorrhage, often in deep brain locations.
- Small nidus size, deep venous drainage, and deep AVM location correlated with hemorrhage in children.
- Ruptured pediatric AVMs carried a higher risk of subsequent hemorrhage compared to unruptured ones.
Conclusions:
- Pediatric AVMs exhibit distinct features, including a higher propensity for hemorrhage.
- Deep AVM location, small nidus, and exclusively deep drainage are risk factors for hemorrhage in children.
- Nonconservative treatment strategies are suggested to be more beneficial for pediatric AVMs than conservative management.
Background:
Clinical follow-up data of pediatric patients with cerebral arteriovenous malformations (AVMs) are limited. This study investigated the characteristics of AVMs in children and analyzed the clinical outcomes of multimodality therapy in pediatric patients with AVMs at a single center.
Methods:
This retrospective study included consecutive patients diagnosed with AVMs at our institution between August 2008 and June 2018. Data on demographic characteristics, AVM features, and clinical outcomes were collected. Patients aged <18 years at admission were defined as children.
Results:
Overall, 1009 patients with AVMs were included, with 304 (30.1%) patients aged <18 years. AVMs in pediatric patients were more likely to present with intracranial hemorrhage, mostly located in deep areas of the brain. A small nidus, exclusively deep drainage, and deep AVM location were associated with hemorrhage in children; Kaplan-Meier analysis revealed that patients with ruptured AVMs had a higher risk of developing a follow-up hemorrhage than those with unruptured AVMs. Among 290 children who were followed up, the multivariate regression analysis showed that a higher pretreatment modified Rankin Scale score, deep AVM location, and conservative treatment were significantly associated with unfavorable outcomes.
Conclusions:
In pediatric patients, AVMs were more likely to present with intracranial hemorrhage than that in adults. Hemorrhagic presentation in children was associated with a small nidus, exclusively deep drainage, and deep AVM location. Pediatric patients with ruptured AVMs had significantly higher risks of follow-up hemorrhage than those with unruptured AVMs. Our clinical results suggest that nonconservative treatment is better for pediatric patients with AVMs.
