OBJECTIVE Pediatric deep brain arteriovenous malformations (bAVMs) represent a unique management challenge given their higher cumulative risk of hemorrhage as well as a higher risk of treatment. Better understanding of hemorrhage risk in this patient population will lead to a better decision-making process for patient management. METHODS The authors retrospectively reviewed their institutional bAVM database from 1990 to 2019 and included patients younger than 21 years who had deep-seated bAVMs. They present the annual hemorrhage risk, during the natural history and after treatment, and functional outcomes. RESULTS Thirty-one pediatric patients were included in this study (13 males and 18 females) with a mean age of 11.8 (SD 4.4) years. The most frequent presenting symptoms were headache (54.8%), weakness (38.7%), and seizure (22.6%). The mean follow-up duration was 13.14 (SD 12.5) years, during which 7 (22.6%) AVMs were obliterated, 10 (32.3%) individuals experienced hemorrhage, and the modified Rankin Scale score worsened in 8 (25.8%) patients. The annual natural history risk of hemorrhage was 3.24% per patient, and the overall annual hemorrhage risk after treatment was 1.98% per patient. In particular, the risk was reduced to 0.64% per patient in the stereotactic radiosurgery (SRS) group. Non-White race showed a trend of higher rupture at presentation (OR 5 [95% CI 0.84–41.68], p = 0.09). Female sex was associated with higher odds (OR 13.076 [95% CI 1.424–333.591], p = 0.048) and SRS was associated with lower odds (OR 0.122 [95% CI 0.011–0.862], p = 0.049) of follow-up hemorrhage. CONCLUSIONS Given the substantial cumulative risk of lifelong hemorrhagic stroke in pediatric patients, timely definitive treatment is warranted. SRS may be beneficial when the risk-benefit profile is deemed acceptable.

中文翻译：

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儿科患者深部脑动静脉畸形的自然史和治疗

客观的鉴于其较高的累积出血风险以及较高的治疗风险，小儿深部脑动静脉畸形（bAVM）代表了独特的治疗挑战。更好地了解该患者群体的出血风险将为患者管理制定更好的决策过程。 方法作者回顾性回顾了 1990 年至 2019 年的机构 bAVM 数据库，其中包括 21 岁以下患有深部 bAVM 的患者。它们呈现了自然病程期间和治疗后的年度出血风险以及功能结果。 结果本研究纳入了 31 名儿童患者（13 名男性和 18 名女性），平均年龄为 11.8 (SD 4.4) 岁。最常见的症状是头痛（54.8%）、虚弱（38.7%）和癫痫发作（22.6%）。平均随访时间为 13.14 (SD 12.5) 年，期间 7 例 (22.6%) 动静脉畸形消失，10 例 (32.3%) 例患者出现出血，8 例 (25.8%) 例患者改良 Rankin 量表评分恶化。每名患者的年度自然病程出血风险为 3.24%，治疗后的总体年度出血风险为每名患者 1.98%。特别是，立体定向放射外科 (SRS) 组中每位患者的风险降低至 0.64%。非白人种族在就诊时表现出破裂率较高的趋势（OR 5 [95% CI 0.84–41.68]，p = 0.09）。女性与较高的随访几率相关（OR 13.076 [95% CI 1.424–333.591]，p = 0.048），SRS 与较低的随访几率相关（OR 0.122 [95% CI 0.011–0.862]，p = 0.049）出血。 结论鉴于儿科患者终生出血性中风的累积风险很大，因此需要及时进行彻底治疗。当风险收益状况被认为可以接受时，SRS 可能是有益的。