• Elias Oulasvirta, Päivi Koroknay-Pál, Ahmad Hafez, Elseoud Ahmed Abou AA Department of Diagnostic Radiology, Helsinki University Hospital, Finland., Hanna Lehto, and Aki Laakso.
• Department of Neurosurgery, Helsinki University Hospital, and Clinical Neurosciences, University of Helsinki, Helsinki, Finland.
• Neurosurgery. 2019 Jan 1; 84 (1): 151-159.

BackgroundPopulation-based long-term data on pediatric patients with cerebral arteriovenous malformations (AVMs) are limited.ObjectiveTo clarify the characteristics and long-term outcome of pediatric patients with AVM.MethodsA retrospective analysis was performed on 805 consecutive brain AVM patients admitted to a single center between 1942 and 2014. The patients were defined as children if they were under 18 yr at admission. Children were compared to an adult cohort. Changing patterns of presentation were also analyzed by decades of admission.ResultsThe patients comprised 127 children with a mean age of 12 yr. The mean follow-up time was 21 yr (range 0-62). Children presented more often with intracerebral hemorrhage (ICH) but less often with epilepsy than adults. Basal ganglia, cerebellar, and posterior paracallosal AVMs were more common in pediatric than in adult patients. Frontal and temporal AVMs, in contrast, were more common in adult than in pediatric patients. As the number of incidentally and epilepsy-diagnosed AVMs increased, ICH rates dropped in both cohorts. In total, 22 (82%) pediatric and 108 (39%) adult deaths were assessed as AVM related. After multivariate analysis, small AVM size and surgical treatment correlated with a favorable long-term outcome.ConclusionHemorrhagic presentation was more common in children than in adults. This was also reflected as lower prevalence of epileptic presentation in the pediatric cohort. Lobar and cortical AVM locations were less frequent, whereas deep and cerebellar AVMs were more common in children. Hemorrhagic presentation correlated negatively with incidentally and epilepsy-diagnosed AVMs. In children, AVM was a major cause of death, but in adults, other factors contributed more commonly to mortality.

13 keywords...

hide…