Paediatric Cerebral Arteriovenous Malformation: Outcomes from a Singapore Children's Hospital |
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| Affiliation: | 1. Neurosurgical Service, KK Women''s and Children''s Hospital, 100 Bukit Timah Road, 229899 Singapore;2. Department of Neurosurgery, National Neuroscience Institute, Singapore;3. SingHealth Duke-NUS Neuroscience Academic Clinical Program, Singapore, 11 Jalan Tan Tock Seng, 308433 Singapore;1. Neurosurgical Service, KK Women''s and Children''s Hospital, 100 Bukit Timah Road, 229899 Singapore;2. Department of Neurosurgery, National Neuroscience Institute, Singapore;3. SingHealth Duke-NUS Neuroscience Academic Clinical Program, Singapore, 11 Jalan Tan Tock Seng, 308433 Singapore;1. Department of Neurology, Massachusetts General Hospital, Boston, MA, United States;2. Office of Statistics and Evaluation, Massachusetts Department of Public Health, Boston, MA, United States;3. Department of Emergency Medicine, Massachusetts General Hospital, Boston, MA, United States;1. Department of Neurosurgery and Brain and Nerve Research Laboratory, The First Affiliated Hospital of Soochow University, Jiangsu, China;2. Department of Neurosurgery, Brigham and Women''s Hospital, Harvard Medical School, 75 Francis Street, Boston, MA 02115, USA;3. Department of Neurosurgery, Amsterdam University Medical Centers, Amsterdam, the Netherlands;4. Department of Radiology, Brigham and Women''s Hospital, Boston, MA, USA;5. Reveal Pharmaceuticals, Cambridge, MA, USA;6. Research Information Systems and Computing, Mass General Brigham, Boston, MA, USA;7. Boston Children''s Hospital Informatics Program, Boston, MA, USA;8. Department of Computer Science, Loyola University, Chicago, IL, USA;9. Division of Rheumatology, Immunology and Allergy, Brigham and Women''s Hospital, Boston, MA, USA;10. Department of Neurology, Massachusetts General Hospital, Boston, MA, USA;11. Biostatistics, Harvard T.H. Chan School of Public Health, Boston, MA, USA;12. Channing Division of Network Medicine, Brigham and Women''s Hospital, Boston, MA, USA;1. Department of Neurology, Korea University Ansan hospital, Korea University College of Medicine, Ansan, South Korea;2. Department of Neurology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea;3. Department of Radiology and Research, Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea;1. Medical Sciences Postgraduation Program, Universidade de Fortaleza (UNIFOR), Fortaleza, Ceará, 60811-905, Brazil;2. Medicine Program, Universidade de Fortaleza (UNIFOR), Fortaleza, Ceará, 60811-905, Brazil;3. Neurology Department, Hospital Geral de Fortaleza, Fortaleza, Ceará, 60150-160, Brazil;4. Medicine Program, Centro Universitário Christus (UNICHRISTUS), Fortaleza, Ceará, 60190-180, Brazil;1. Department of Neuroradiology, ASST Sette Laghi, University of Insubria, Varese, Italy;2. Division of Neurosurgery, Department of Biotechnology and Life Sciences, University of Insubria, Varese, Italy;3. Neurosurgery Unit, Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, Brescia, Italy;4. Associate Professor, Department of Neurosurgery, All India Institute of Medical Sciences, New Delhi, India;5. Department of Department of Neuroradiology, ARNAS Civico di Palermo, Palermo, Italy;6. Department of Anesthesiology and Resuscitation, ASST Sette Laghi, Varese, Italy;7. Department of Neuroradiology, ASST Monza, Monza, Italy;8. Department of Neurosurgery, Mayo Clinic, Rochester, Minnesota, USA |
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| Abstract: | ObjectivesPaediatric brain arteriovenous malformation (bAVM) is a rare and distinct clinical entity. There is a growing body of literature that support the success of multimodality approaches for this difficult condition. The authors aim to firstly, describe our institutional experience with a consecutive series of patients and next, corroborate our results with current literature.Material and methodsThis is a single institution, retrospective study conducted over a 20-year period. Patients less than 19 years old with bAVM were included. Variables of interest included patient demographics, clinical presentation, neuroimaging features, bAVM characteristics and treatment modality. Functional outcomes were measured with modified Rankin scale (mRS).ResultsThere were 58 paediatric bAVMs, presenting at a mean age of 8.7 ± 4.2 years, and followed up for a mean duration of 7.7 years. Thirty-six patients (62.1%) underwent microsurgical resection, 10 patients had stereotactic radiosurgery (17.2%) and 2 patients had endovascular treatment (3.4%). 50 patients (86.2%) had a favourable outcome at 1-year follow up. Microsurgical resection and SRS had similar obliteration rates (resection 83.3%; SRS 80.0%) and recurrence (resection 10.0%; SRS 12.5%). There were 6 cases of bAVM recurrence (12.8%). This subgroup was noted to be less than 7.5 years old at presentation (OR 15.0, 95% CI 1.56 – 144), and less likely to present with bAVM rupture (OR 0.11, 95% CI 0.01 – 0.96).ConclusionThis study describes our experience in managing paediatric bAVM, whereby monomodal therapy can still be effective. Of note, we also demonstrate the role of extended surveillance to detect recurrence. |
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| Keywords: | Vascular malformation Paediatric cerebral arteriovenous malformation Cerebral arteriovenous malformation in children |
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