Medical Student University of Pittsburgh School of Medicine Pittsburgh, Pennsylvania, United States
Disclosure(s):
Nikhil Sharma, MS: No financial relationships to disclose
Introduction: While surgical resection is often appropriate for superficial pediatric arteriovenous malformations (pAVMs), it is generally too morbid for pAVMs in deep locations (e.g. basal ganglia, internal capsule, thalamus, brainstem). This study aims to demonstrate that multimodal AVM treatment still provides good angiographic and functional outcomes for deep lesions.
Methods: We conducted a retrospective review of deep pAVM outcomes in 79 patients from January 1988 – December 2021. Collected data included patient demographic characteristics and presenting symptoms, presenting modified Rankin Scale (mRS) score, radiographic characteristics, management strategy, radiographic outcomes, adverse outcomes, and clinical outcomes as indicated by follow-up mRS score. A good outcome was defined as a follow-up mRS score of ≤ 2 while a poor outcome was defined as a follow-up mRS score of ≥ 3. Statistical analyses were then performed to identify factors associated with functional outcomes.
Results: Over an average follow-up duration of 76.7 months, there was a 55% angiographic obliteration rate with 76% of patients having a good functional outcome on follow up (mRS ≤ 2). Presenting symptoms and radiographic characteristics were not significantly associated with long-term functional outcomes. There was a significantly higher rate of post treatment hemorrhage in patients with a poor versus good outcome (10.5% vs. 0%, p=0.010). On multiple logistic regression analysis, poor long-term functional outcome was associated with poor presenting mRS score (p=0.012), craniotomy for hemorrhage (p=0.048), and post-treatment hemorrhage (p=0.016).
Conclusion : Satisfactory angiographic obliteration rates and good long-term functional outcomes can be achieved with multimodality treatment of deep pAVMs. Poor outcome was predicted by poor presenting mRS, craniotomy for hemorrhage, and post-treatment hemorrhage.
