O-031 Endovascular Management of Intracranial Arteriovenous Malformations with Various Angioarchitecture Features in the Pediatric Population: Is Spetzler-Martin Grading Predictive?. (29th July 2016)

• Record Type: Journal Article
• Authors: Honarmand, A; Ansari, S; Hurley, M; Golnari, P; Potts, M; Jahromi, B; Shaibani, A
• Is Part Of: Journal of neurointerventional surgery. Volume 8(2016)Supplement 1
• Page Start: A20
• Page End: A21
• Publication Date: 2016-07-29
• Subjects: Nervous system -- Surgery -- Periodicals; Cerebrovascular disease -- Surgery -- Periodicals; 617.48
• DOI: 10.1136/neurintsurg-2016-012589.31
• Languages: English
• ISSNs: 1759-8478

Abstract

Abstract : Purpose: We performed this study to investigate the potential predictors of long-term outcome in endovascular management of intracranial arteriovenous malformations (AVMs) with/without surgical resection in the pediatric population. Materials and methods: Consecutive pediatric patients (<18 years) presenting with intracranial AVMs verified by CT/MR/DSA imaging studies were enrolled in the study. Baseline demographics, presenting symptoms, angioarchitecture characteristics [location, compact/diffuse nidus type, maximum nidus diameter, superficial/deep drainage, associated flow-induced aneurysm and/or venous varix/stenosis/ectasia, number of arterial feeders/draining veins, Spetzler-Martin Grading (SMG) scores, and ruptured/unruptured lesions], treatment strategy (endovascular embolization and/or surgical resection versus conservative management), procedural complication, recurrence, and long-term functional outcome were obtained. Ninety days modified Rankin Scale score of ≤2 and achieving developmental milestones were used to determine good functional outcome as appropriate. Independent samples T test, chi square, and logistic regression analyzes were performed for statistical analyzes. Results: Fifty-eight cases (m/f: 38/20; mean age [(range)±SD: 10.99 (0.5–17) ±4.09 years] presented with 29 ruptured versus 29 unruptured AVMs. Presenting symptoms included severe headaches (35.8%), occasional mild-moderate headache (22.6%), incidental finding (22.6%), seizure (9.4%), focal neurological deficits (15.1%), and loss of consciousness 20.8%), respectively. Single or multi-session endovascular embolization was performed either alone or prior to surgical resection while three cases were managed conservatively. Procedural complication and lesion recurrence were encountered in 6.9% and 5.2% of cases, respectively. Good functional outcome was achieved in 49 (84%) of cases. Angioarchitecture features of the lesions are presented in the table. No significant association was observed between SMG and final outcome (P = 0.80). Regression analysis of clinical presentation, lesion characteristics, and treatment-related variables revealed that rupture and severe onset of headache were independent predictors of poor long-term functional outcome (P = 0.006, OR:3.5). Seven out of nine cases with poor clinical outcome presented with ruptured AVMs with unfavorable preprocedural mRS score in eight of them. Conclusions: In our study, size, eloquent location, and complex angioarchitecture of intracranial AVMs were not predictors of outcome while presentation and ruptured/unruptured status of the lesions were significant predictors of long-term clinical outcome in treatment strategy with endovascular approach. Disclosures: A. Honarmand: None. S. Ansari: None. M. Hurley: None. P. Golnari: None. M. Potts: None. B. Jahromi: None. A. Shaibani: None.