Introduction: Children with brain arteriovenous malformations (BAVM) are at risk of life-threatening hemorrhage, severe clinical event and invasive intervention in their early lives. Therefore, our aim was to analyze various features of BAVM to predict the risk of severe outcome in children before treatment.
Methods: We identified all consecutive children admitted to Beijing Tiantan Hospital for BAVMs between July 2009 and December 2014. The effects of demographic characteristics and BAVM morphology on clinical outcomes were studied using univariate and multivariable regression analyses.
Results: A total of 134 pediatric BAVM cases were identified, 41 (30.6%) of which experienced severe clinical course before treatment. Periventricular nidus location (OR, 3.949; 95%CI, 1.439-10.838; P=0.008), non-temporal lobe location (OR, 2.891; 95%CI, 1.086 –7.695; P=0.034) and long pial draining vein (OR, 3.638; 95%CI, 1.416-9.349; P=0.007) were independent predictors of severe clinical outcome, and were also associated with early unfavorable events in pediatric BAVMs (P<0.05). BAVMs can be further classified into three types with these predictors, The annual rate of severe morbidity in children with Type I and II BAVMs were higher at 4.9% and 5.2% than that of Type III (P<0.05). The severe outcome-free survival rates were also lower for children with Type I and II BAVMs (log-rank, P=0.012).
Conclusions: Careful evaluation of BAVM location and venous drainage is recommended to identify children at higher risk for unfavorable outcome. Periventricular, non-temporal location and long pial draining vein were associated with an increased risk for unfavorable outcome in pediatric patients with untreated BAVM.
Patient Care: With the morphologic features predictive of poor outcomes for children with untreated bAVM and the prospecitve classification, it would be more helpful to find bAVM children with higher risk for poor outcomes if there is not treatment, namely who might benefit more from the treatment.
Learning Objectives: By the conclusion of this session, participants should be able to: 1) Describe the importance of careful evaluation of location and venous drainage in pediatric bAVM management, 2) Discuss, in small groups, morphologic features predictive of poor outcomes of children with bAVM, 3) Identify an effective pre-treatment risk stratification system to select those with higher risk for poor outcomes if there is not treatment.