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Long-term outcomes and prognostic predictors of 111 pediatric hemorrhagic cerebral arteriovenous malformations after microsurgical resection: a single-center experience

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Abstract

Comparison in pediatric hemorrhagic arteriovenous malformations (AVMs) to clarify the long-term neurological outcomes and prognostic predictors after surgical intervention was relatively rare, especially in the selection of surgical timing. The objective of this study was to elucidate these points. The authors retrospectively reviewed the pediatric hemorrhagic AVMs resected in their neurosurgical department between March 2010 and June 2017. The natural history was represented by rupture risk. Neurological outcome was assessed with the modified Rankin Scale (mRS) for children. Multivariate logistic regression analyses were used to assess the risk factors for disability (mRS > 2). The hemorrhagic early phase was defined as less than 30 days after bleeding. The corresponding prognosis of different surgical timing (early intervention or delayed intervention) was compared after propensity-score matching (PSM). A total of 111 pediatric hemorrhagic AVM patients were evaluated. The average patient age was 11.1 ± 4.0 years, with a mean follow-up of 4.3 ± 2.1 years. The annualized rupture risk was 9.3% for the pediatric hemorrhagic AVMs, and the annualized re-rupture risk was 9.8%. 7.2% of the patients had disabilities (mRS > 2) and 82.0% achieved neurological deficit-free (mRS < 2) at the last follow-up. Pre-treatment mRS (P = 0.042) and flow-related aneurysms (P = 0.039) were independent factors for long-term disability. In terms of short-term outcomes, early intervention was better than delayed intervention (P = 0.033), but the long-term outcomes were similar between the two groups (P = 0.367). Surgical intervention for pediatric hemorrhagic AVMs is recommended, most of the patients can achieve good neurological outcomes. Moreover, early surgical intervention is preferred after the initial hemorrhage.

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Acknowledgment

We thank the Cerebrovascular Surgery Study Project of Beijing Tiantan Hospital.

Funding

This study was supported by the National Key Technology Research and Development Program of the Ministry of Science and Technology of China (grants 2006BAI12B04), Beijing Municipal Organization Department Talents Project (grant 2015000021469G219), Beijing Municipal ST Commission (grant D161100003816005).

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Author notes

  1. Zhenghai Deng and Yu Chen contributed equally to this work as co-first authors.

Authors and Affiliations

  1. Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, 100070, China

    Zhenghai Deng, Yu Chen, Li Ma, Ruinan Li, Shuo Wang, Dong Zhang, Yuanli Zhao & Jizong Zhao

  2. China National Clinical Research Center for Neurological Diseases, Beijing, China

    Zhenghai Deng, Li Ma, Shuo Wang, Dong Zhang, Yuanli Zhao & Jizong Zhao

  3. Stroke Center, Beijing Institute for Brain Disorders, Beijing, China

    Zhenghai Deng, Li Ma, Shuo Wang, Dong Zhang, Yuanli Zhao & Jizong Zhao

  4. Beijing Key Laboratory of Translational Medicine for Cerebrovascular Disease, Beijing, China

    Zhenghai Deng, Li Ma, Shuo Wang, Dong Zhang, Yuanli Zhao & Jizong Zhao

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  1. Zhenghai Deng
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Contributions

ZD, YC, and LM contributed conception and design of the study; ZD and LM organized the database; YC, LM, and RL performed the statistical analysis; YC wrote the first draft of the manuscript; SW, DZ, YZ, and JZ wrote sections of the manuscript. All authors contributed to manuscript revision, read, and approved the submitted version.

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Correspondence to Jizong Zhao.

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All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional review boards at both institutions and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

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Deng, Z., Chen, Y., Ma, L. et al. Long-term outcomes and prognostic predictors of 111 pediatric hemorrhagic cerebral arteriovenous malformations after microsurgical resection: a single-center experience. Neurosurg Rev 44, 915–923 (2021). https://doi.org/10.1007/s10143-019-01210-4

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