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  • An Assessment of Clinical Outcomes in Pediatric Brain Arteriovenous Malformation (bAVM) Patients

    Final Number:

    Isaac Josh Abecassis MD; John D. Nerva MD; Jason Barber MS; Jason K. Rockhill MD, PhD; Richard G. Ellenbogen MD, FACS; Louis J. Kim MD; Laligam N. Sekhar MD, FACS

    Study Design:

    Subject Category:
    Vascular Malformations

    Meeting: AANS/CNS Cerebrovascular Section 2016 Annual Meeting

    Introduction: Pediatric brain arteriovenous malformations (bAVMs) are rare and represent the most common cause of hemorrhagic stroke. Pediatric patients demonstrate superior outcomes in comparison to adult patients with similar lesions and presentations. Most series of pediatric bAVM clinical outcomes utilize the modified Rankin scale (mRS), despite a lack of validation in pediatric patients.

    Methods: We identified 40 pediatric patients treated with multimodality therapy. We contacted the parents of the patients and administered the Pediatric Quality of Life Inventory (PedsQL) – a well-validated tool in pediatric outcomes that quantifies performance in a physical, emotional, social, and school domains. We also reviewed clinical information from the patients’ medical charts. We also reviewed the literature for prior clinical outcome reports in pediatric bAVM (Table 1).

    Results: Average age at time of intervention was 11.7 years (See Table 2), with an average follow up time of 6.6 years. Sixty three percent of patients presented with hemorrhage. mRS at presentation ranged from 0 to 5, with a mean value of 2.2, and 1.3 at most recent follow up. The average health related quality of life (HRQL) score was 69.3 +/-25. This is lower than mild TBI (82), higher than spina bifida (60), and similar to pediatric stroke and brain tumor (see Table 3). The mRS at most recent follow up was statistically significantly related to the “Physical” subscore of the PedsQL survey (p=0.013), but not as closely corrrelated to the overall PedsQL score (p=0.075). Hemorrhagic presentation, Spetzler-Martin grade, surgical intervention, angiographic cure, and discharge location did not correlate with PedsQL scores. Patients with a ventriculoperitoneal shunt had a lower PedsQL score (p=0.017).

    Conclusions: Long-term clinical outcomes for pediatric bAVM patients are under-analyzed. An accurate understanding of HRQL is contingent on utilizing validated toolsets, such as the PedsQL. Important cognitive assessments are missed with conventional follow up.

    Patient Care: This study highlights the variety of metrics reported in the literature for documenting “clinical outcomes” in pediatric neurosurgical patients in general, and pediatric bAVM patients more particularly. It also demonstrates an inability of the modified rankin score (mRS) system to capture overall HRQL. More thorough evaluation of pediatric bAVM patients can set the stage for improved neuropsychological interventions and clinical outcomes.

    Learning Objectives: (1) To review the concept of “functional clinical outcome” as it relates to prior pediatric neurosurgical series, as well as prior clinical reports of pediatric bAVM outcomes. (2) To evaluate health related quality of life (HRQL) scores for pediatric bAVM patients (3) To screen for variables that are predictive of poor clinical outcomes, in an effort to better optimize patient care.

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