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Updated: Jan 16, 2026
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Comprehensive Endovascular and Open Surgical Management of Cerebral Arteriovenous Malformations
Published on: October 20, 2017
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Long-term outcomes in pediatric brain AVMs: beyond radiological cure
Francesco M C Lioi1,2, Alessandro De Benedictis2, Davide Luglietto2,3
1Department of Neurosurgery, Policlinico Umberto I, Sapienza University of Rome, Rome, Italy.
Brain & Spine
|October 6, 2025
Summary
Pediatric brain arteriovenous malformations (bAVMs) may recur years after treatment, even with radiological cure. Long-term clinical surveillance is crucial for event-free survival (EFS) in children with bAVMs.
Area of Science:
- Neurology
- Pediatric Neurosurgery
- Vascular Malformations
Background:
- Brain arteriovenous malformations (bAVMs) are often considered cured after successful treatment, confirmed by imaging.
- Recurrence of bAVMs in pediatric patients can occur years post-treatment, necessitating long-term monitoring.
- Event-free survival (EFS) is an important metric for assessing therapeutic success and long-term outcomes in pediatric bAVMs.
Purpose of the Study:
- To evaluate the long-term clinical outcomes and event-free survival (EFS) in pediatric patients treated for brain arteriovenous malformations (bAVMs).
- To determine if radiological cure correlates with sustained freedom from clinical events in pediatric bAVMs.
- To highlight the importance of extended follow-up for detecting late-occurring complications in pediatric bAVMs.
Main Methods:
- Retrospective analysis of 46 pediatric patients with bAVMs treated between 2013 and 2025.
- Systematic collection of clinical data, bAVM characteristics, treatment strategies, and outcomes.
- Kaplan-Meier survival analysis to assess EFS, with functional outcomes evaluated using the modified Rankin Scale (mRS).
Main Results:
- Radiological cure was achieved in 77.5% of patients; 87% had favorable functional outcomes (mRS ≤2) at median follow-up of 56.5 months.
- Clinical events occurred both early and late, with late events predominating, even in patients with confirmed radiological cure.
- Two angiographic recurrences were observed more than 9 years after treatment, indicating late-phase complications.
Conclusions:
- Event-free survival (EFS) is a critical metric for pediatric brain arteriovenous malformations (bAVMs), capturing long-term morbidity.
- Clinical events can persist beyond radiological cure, emphasizing the need for extended follow-up in pediatric bAVM management.
- Long-term surveillance is essential for pediatric patients treated for bAVMs to monitor for late-occurring events and ensure sustained therapeutic success.
