Arteriovenous malformations (AVMs) are a major cause of intracerebral hemorrhage in children, resulting in significant morbidity and mortality. Moreover, the rate of AVM recurrence in children is significantly higher than in adults. The aim of this study was to define the risk of delayed pediatric AVM (pAVM) recurrence following confirmed radiological obliteration. Further understanding of this risk could inform the role of long-term radiological surveillance.

The authors conducted a retrospective review of ruptured and unruptured pAVM cases treated at a single tertiary care referral center between 1994 and 2019. Demographics, clinical characteristics, treatment modalities, and AVM recurrence were analyzed.

A total of 102 pediatric patients with intracranial AVMs, including 52 (51%) ruptured cases, were identified. The mean patient age at presentation was 11.2 ± 4.4 years, and 51 (50%) patients were female. The mean nidus size was 2.66 ± 1.44 cm. The most common Spetzler-Martin grades were III (32%) and II (31%). Stereotactic radiosurgery was performed in 69.6% of patients. AVM obliteration was radiologically confirmed in 68 (72.3%) of 94 patients with follow-up imaging, on angiography in 50 (73.5%) patients and on magnetic resonance imaging in 18 (26.5%). AVM recurrence was identified in 1 (2.3%) of 43 patients with long-term surveillance imaging over a mean follow-up of 54.7 ± 38.9 months (range 2–153 months). This recurrence was identified in a boy who had presented with a ruptured AVM and had been surgically treated at 5 years of age. The AVM recurred 54 months after confirmed obliteration on surveillance digital subtraction angiography. Two other cases of presumed AVM recurrence following resection in young children were excluded from recurrence analysis because of incomplete sets of imaging available for review.

AVM recurrence following confirmed obliteration on imaging is a rare phenomenon, though it occurs more frequently in the pediatric population. Regular long-term follow-up with dedicated surveillance angiography is recommended even after obliteration following resection.

动静脉畸形（AVMs）是儿童脑出血的主要原因，导致显着的发病率和死亡率。此外，儿童 AVM 复发率明显高于成人。本研究的目的是确定确诊的放射学闭塞后延迟儿科 AVM (pAVM) 复发的风险。对这种风险的进一步了解可以为长期放射监测的作用提供信息。

作者对 1994 年至 2019 年间在一家三级护理转诊中心治疗的破裂和未破裂 pAVM 病例进行了回顾性分析。分析了人口统计学、临床特征、治疗方式和 AVM 复发情况。

共确定了 102 例颅内 AVM 儿科患者，包括 52 例 (51%) 破裂病例。就诊时患者的平均年龄为 11.2 ± 4.4 岁，51 名 (50%) 患者为女性。平均病灶大小为 2.66 ± 1.44 cm。最常见的 Spetzler-Martin 等级为 III (32%) 和 II (31%)。69.6% 的患者接受了立体定向放射外科手术。在 94 名患者中，68 名 (72.3%) 的影像学检查证实了 AVM 闭塞，其中 50 名 (73.5%) 患者的血管造影和 18 名 (26.5%) 的磁共振成像证实了 AVM 闭塞。在 54.7 ± 38.9 个月（范围 2-153 个月）的平均随访期内，43 名接受长期监测成像的患者中有 1 名（2.3%）发现 AVM 复发。这种复发是在一名患有 AVM 破裂并在 5 岁时接受过手术治疗的男孩身上发现的。AVM 在监测数字减影血管造影确认闭塞后 54 个月复发。由于可供审查的影像集不完整，另外两例在幼儿切除后假定 AVM 复发的病例被排除在复发分析之外。

在影像学上证实为闭塞后 AVM 复发是一种罕见的现象，尽管它在儿科人群中更常见。即使在切除后闭塞后，也建议定期进行长期随访，并进行专门的监测血管造影。