Rupture Of Arteriovenous Malformation Research Articles

Passive smoking may be associated with bleeding of cerebral arteriovenous malformation in non-smoking women: a retrospective analysis.

Smoking has been considered to be a risk factor for cardiovascular disease, cancer, depression and other diseases in previous reports, and active smoking is considered to be a risk factor for hemorrhagic stroke. In addition, a retrospective study showed that male smokers were at increased risk of bleeding from arteriovenous malformation (AVM), compared with non-smokers. However, the effect of passive smoking on rupturing of cerebral AVM in non-smoking women has not been addressed. This study aimed to assess the impact of tobacco exposure on AVM bleeding risk in non-smoking women. A total of 393 non-smoking women diagnosed with AVM were included. They were divided into a bleeding group (205 women) and a non-bleeding group (188 women). We conducted univariate and multivariate analysis on these two groups. In univariate analysis, risk factors that might be related to AVM bleeding were analyzed. In multivariate analysis, the relationship between passive smoking and AVM rupture was analyzed by correcting confounding factors. Multivariate analysis showed that the proportion of passive smoking was statistically different between the bleeding group and the non-bleeding group (OR = 1.609; CI = 1.031-2.509; p = 0.036). Passive smoking may increase the risk of AVM bleeding in non-smoking women. This increased risk may be related to the inflammatory response, vascular wall damage, hemodynamic disorders, changes in atherosclerosis and changes in gene expression caused by passive smoking.

Acute Postoperative Visual Loss Due to Occipital Arteriovenous Malformation Rupture During Anesthesia

<p>We report a case of occipital arteriovenous malformation (AVM) rupture during anaesthesia, causing postoperative visual loss in a 43-year-old man with American Society of Anesthesiologist class I. He was scheduled for an operation for the correction of right index deformity. He was a healthy, middle-sized man without any previous systemic disease. He had sustained a cutting injury to the right index finger 1 year ago and had undergone microsurgery. As he was unsatisfied with the surgical results, he was arranged for another correction surgery. After the 2-h surgery, he recovered from anaesthesia, but complained of a mild headache over the occipital region. He left the post-operative recovery room thereafter and was discharged the next day. Three days later, he came to our surgical outpatient department for follow-up. He complained of blurred vision since the surgery. The ophthalmologist found left-sided homonymous visual field loss with incomplete hemianopia. He was referred to the neurological section and after a series of examinations including brain computed tomography, the diagnosis of AVM rupture in the right occipital region was confirmed.</p> <p> </p>

Untangling the Modern Treatment Paradigm for Unruptured Brain Arteriovenous Malformations.

Brain arteriovenous malformations (AVMs) often present treatment challenges. Patients with unruptured AVMs must consider not only whether they want to be treated, but what treatment modality they would prefer. Vascular neurosurgeons, neurointerventional surgeons, and stereotactic radiosurgeons must in turn guide their patients through the most appropriate treatment course considering the risk of AVM rupture, an individual AVM’s characteristics, and patient preferences. In this review we will look at how the clinical trial “A Randomized Trial of Unruptured Brain Arteriovenous Malformations (ARUBA)” has influenced the approach to unruptured brain AVMs and the treatment modalities available to clinicians to deal with these formidable lesions.

Hereditary Hemorrhagic Telangiectasia and Arterio-Venous Malformations-From Diagnosis to Therapeutic Challenges.

Hereditary hemorrhagic telangiectasia is a rare autosomal dominant vascular disease defined by the presence of mucosal and cutaneous telangiectasia and visceral arterio-venous malformations. The latter are abnormal capillary-free direct communications between the pulmonary and systemic circulations with the following consequences: arterial hypoxemia caused by right-to-left shunts; paradoxical embolism with transient ischemic attack or stroke and brain abscess caused by the absence of the normally filtering capillary bed; and hemoptysis or hemothorax due to the rupture of the thin-walled arterio-venous malformations (particularly during pregnancy). It is frequently underdiagnosed, commonly presenting as complications from shunting through arterio-venous malformations: dyspnea, chronic bleeding, or embolism. Arterio-venous malformations are present not only in the lungs, but can also be found in the liver, central nervous system (mainly in the brain), nasal mucosa, or the gastrointestinal tract. The first choice of therapy is embolization of the afferent arteries of the arterio-venous malformations, a minimally invasive procedure with a high efficacy, a low morbidity, and low mortality. Other therapeutic modalities are surgery (resection) or stereotactic radiosurgery (using radiation). Routine screening for arterio-venous malformations is indicated in patients diagnosed with this condition and can prevent severe complications such as acute hemorrhages, brain abscesses, or strokes. Clinicians should provide a long-term follow-up for patients with arterio-venous malformations, in an effort to detect their growth or reperfusion in case of previously treated malformations. In spite of two experts’ consensuses, it still possesses multiple therapeutic challenges for physicians, as several aspects regarding the screening and management of arterio-venous malformations still remain controversial. Multidisciplinary teams are especially useful in complex cases.

Stereotactic radiosurgery for ruptured versus unruptured intracranial arteriovenous malformations.

Background: There are a limited data examining the effects of prior hemorrhage on outcomes after stereotactic radiosurgery (SRS). The goal of this study was to identify risk factors for arteriovenous malformation (AVM) rupture and compare outcomes, including post-SRS hemorrhage, between patients presenting with ruptured and unruptured AVMs.Methods: A retrospective review of consecutive patients undergoing SRS for intracranial AVMs between 2009 and 2019 at our institution was conducted. Chi-square and multivariable logistic regression analyses were utilized to identify patient and AVM factors associated with AVM rupture at presentation and outcomes after SRS including the development of recurrent hemorrhage in both ruptured and unruptured groups.Results: Of 210 consecutive patients with intracranial AVMs treated with SRS, 73 patients (34.8%) presented with AVM rupture. Factors associated with AVM rupture included smaller AVM diameter, deep venous drainage, cerebellar location, and the presence of intranidal aneurysms (P < 0.05). In 188 patients with adequate follow-up time (mean 42.7 months), the overall post-SRS hemorrhage rate was 8.5% and was not significantly different between ruptured and unruptured groups (10.3 vs. 7.5%, P = 0.51). There were no significant differences in obliteration rate, time to obliteration, or adverse effects requiring surgery or steroids between unruptured and ruptured groups.Conclusion: Smaller AVM size, deep venous drainage, and associated intranidal aneurysms were associated with rupture at presentation. AVM rupture at presentation was not associated with an increased risk of recurrent hemorrhage or other complication after SRS when compared to unruptured AVM presentation. Obliteration rates were similar between ruptured and unruptured groups.

Validation of the Ruptured Arteriovenous Malformation Grading Scale in a pediatric cohort.

Pediatric brain arteriovenous malformations (AVMs) are the leading cause of spontaneous intracranial hemorrhage (SICH) in children. Although the incidence of SICH is low in pediatric populations, such events cause substantial morbidity. The recently created Ruptured Arteriovenous Malformation Grading Scale (RAGS) is proposed as a reliable and novel grading system to specifically serve as a predictor of clinical outcomes in patients following AVM rupture, similar to the Hunt and Hess (HH) grade for ruptured aneurysms. While these data are promising, pediatric patients were notably absent from the original study validating the RAGS. Therefore, correlation of the RAGS score with clinical outcomes following AVM rupture in individuals younger than 18 years of age using the RAGS score is needed. The objective of this study was to validate the RAGS in a cohort of pediatric patients with AVMs who presented with hemorrhage, thereby demonstrating the score's generalizability, and expanding its external validity. A cohort of children with ruptured AVMs were retrospectively reviewed. Using disability, measured by the modified Rankin Scale (mRS), as the response variable, the area under the receiver operating characteristic curve (AUROC) was calculated for patients based on their RAGS scores for three time periods. The AUROC values were then compared with those generated by two commonly used clinical grading systems, the HH classification and Glasgow Coma Scale. A total of 81 children who presented with ruptured AVMs were included in the study, with a mean follow-up duration of 4 years. The RAGS score outperformed other clinical grading scales in predicting mRS scores, with AUROC values of 0.81, 0.82, and 0.81 at three distinct follow-up periods. The RAGS score correlated well with the clinical outcome after AVM rupture in pediatric patients. Additional validation studies across multiple treatment centers are needed to further demonstrate the generalizability of the scoring system.

Arterio-Venous Brain Malformation Rupture during Pregnancy, About a Case

AVMs are abnormalities of the intracranial vessels that constitute a connection between the arterial and venous systems and lack an intervening capillary bed. Hemorrhagic presentation of AVM is associated with significant morbidity and mortality; it is an independent predictor of future hemorrhage. AVM rupture is one of the most frequent and important causes of hemorrhagic stroke during pregnancy and puerperium. Whether the risks of AVM rupture increases during pregnancy and puerperium is controversial, but maternal physiological changes in hemodynamics, blood volume, and hormonal effects on the vessel walls could potentially increase the risk of hemorrhage from AVMs during pregnancy and in the postpartum period. For AVM during pregnancy and puerperium, previous studies have demonstrated histologic changes in arteries and arterioles of pregnant women, thought to be mediated by progesterone; the changes included fragmentation of reticular fibers and loss of normal corrugation of elastic fibers, which might play a role in the increased risk for AVM hemorrhage during pregnancy. However, there is insufficient evidence to guide management decisions for ruptured AVMs during pregnancy, and further well-designed, multicenter, perspective clinical trials are needed. We report the case of a young woman, who had an emergency ceasarean surgery for a headeck and consciousness disorder witch evoked eclampsia, while in fact; she had a rupture of arteriovenous malformation following the rupture of a cerebral Arterio-venous malformation in cerebral imaging.

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Mandibular arteriovenous malformations (AVMs) are vascular lesions that are rare in pregnancy but that can be life threatening due to the potential for massive haemorrhage when ruptured.This report describes a 30-year-old woman who presented at 39 weeks of gestation with hypovolemic shock secondary to a massive haemorrhage from her oral cavity. After resuscitation, she underwent an emergency caesarean section indicated for fetal distress. A live infant was born who required neonatal intensive care support. An angiogram was performed post-operatively which demonstrated a mandibular AVM that was selectively embolised. The patient and her newborn ultimately recovered with no further bleeding or complications.This report describes the fourth case of a mandibular AVM in pregnancy published in the literature, that was managed with selective embolisation. More research is required to determine the effect of pregnancy on AVM manifestation and rupture. Antenatal management should be on a case-by-case basis with multi-disciplinary team involvement.

Facilitation of Pediatric Posterior Fossa Vascular Malformation Resection Using Virtual Reality Platform: 2-Dimensional Operative Video.

Pediatric posterior fossa arteriovenous malformations (AVMs) are rare entities that pose significant cumulative lifetime risk of rupture and require treatment. Microsurgical resection remains a good option for definitively treating posterior fossa AVMs in one setting. The drawback of endovascular embolization is the lower rates of nidus obliteration. Although stereotactic radiosurgery is a safe alternative, it takes several years to achieve the treatment goal all the while predisposing the patient to the risk of AVM rupture.1,2 Accurate localization and visualization remain challenging for microsurgical treatment of posterior fossa AVMs.3-5 Small size of a nidus, prone position, and proximity to eloquent areas make these lesions particularly difficult to localize and resect. We present the operative case of a 6-year-old boy with a small, ruptured posterior fossa AVM. After undergoing hematoma evacuation, the patient underwent microsurgical resection of a small right vermian AVM assisted by the virtual reality platform, Surgical Theater (Gates Mills, OH). Our video demonstrates the utility of a virtual augmented reality platform for addressing the challenges posed by a small posterior fossa AVM with respect to the need for precise three-dimensional localization of small lesions. The patient consented to the procedure. The participants and any identifiable individuals consented to publication of his/her image.

165 National Reduction in Cerebral Arteriovenous Malformation Treatment Correlated with Increased Rupture Incidence

INTRODUCTION: In 2014 “A Randomized Trial of Unruptured Brain Arteriovenous Malformations” (ARUBA) concluded that medical management alone was superior to interventional therapy for adult patients with unruptured brain arteriovenous malformations (AVMs). METHODS: 154,297 weighted AVM admissions were identified in the United States from 2003 to 2017 in the National Inpatient Sample. Annual AVM intervention and rupture rates were computed and multivariable logistic regression assessed likelihood of AVM intervention pre- and post-ARUBA. Segmented regression identified significant change-points and fitted segmented linear models for annual intervention and rupture rates. Pearson and Spearman coefficients examined correlation between annual AVM intervention and rupture rates. RESULTS: For unruptured AVMs, intervention proportion and likelihood of receiving intervention decreased following ARUBA (28.1% to 22.3%, P &lt; 0.0001; adjusted odds ratio 0.857, 95% CI 0.751-0.977, P = 0.02). Ruptured AVM admissions increased from 14.7% to 18.6% after ARUBA (P &lt; 0.0001). Between 2003 and 2017, segmented linear regression identified one significant change-point in unruptured AVM intervention rate between 2014 and 2015. Average annual percent change for rupture incidence and intervention rate increased by 0.49% (P=0.0001) and decreased by 1.17% (P = 0.0001), respectively. Annual AVM intervention rates had a strong inverse correlation with annual AVM rupture incidence (Pearson coefficient = -0.82, P = 0.0002). In 2017, the annual AVM rupture rate (20.6%) surpassed the annual AVM intervention rate (19.7%) for the first time. CONCLUSION: Following ARUBA, the odds of intervention for unruptured AVMs have decreased while ruptured AVM incidence has increased. These findings are inversely correlated suggesting that less unruptured AVM treatments may lead to a substantial increase in AVM rupture incidence.

Ultrasound diagnosis of renal arteriovenous malformation in a young adult: An underrecognized cause of recurrent haematuria

AbstractRenal arteriovenous malformations (AVMs) although uncommon are the most underrecognized cause of recurrent haematuria especially in young patients. Although renal AVMs are commonly incidentally detected, life threatening complications such as gross haematuria and AVM rupture have been implicated. Ultrasound is the first line imaging investigation which has a crucial role in treatment planning, post‐procedural, long‐term follow‐up, and assessment of complications associated with renal AVMs. This is a report of a rare case of spontaneous renal AVM in a patient without prior history of renal biopsy or previous trauma. A 26‐year‐old male presented for an ultrasound with recurrent haematuria. This case report highlights the role of ultrasound in the diagnosis, follow‐up and assessment of treatment related complications of renal AVMs.

Pleural Empyema Concurrent with Arteriovenous Malformation of the Oral and Maxillofacial Regions: A Case Report

Introduction: Pleural empyema is a common disease and involves an increasing number of patients. Here, we describe a case of pleural empyema and bacteremia secondary to hemorrhage of arteriovenous malformation (AVM) in the oral and maxillofacial regions. Case Summary: A 23-year-old female diagnosed with maxillofacial AVM previously presented to our hospital with fever and dyspnea for 8 days. Chest computed tomography (CT) images showed that she had pleural empyema. Bacterial detection showed the growth of Pseudomonas aeruginosa, Actinomyces odontolyticus, and Parvimonas micra. Antibiotic therapy combined with pleural space drainage were not effective until the hemorrhage of the AVM stopped. Conclusion: AVM rupture and bleeding may lead to persistent or refractory infection, and hemostasis is vital in preventing infection secondary to AVM.

VASODILATION OR NEUROPROTECTION? EFFECT OF INTRA-ARTERIAL NIMODIPINE ON SUBARACHNOID HEMORRHAGE INJURED BRAIN

Subarachnoid hemorrhage is a pathological condition of the brain, caused by rupture of intracerebral aneurism or arteriovenous malformation, with high morbidity and mortality rate. SAH may conceive permanent brain damage with persistent disability. Vasospasm is the most characteristic pathological state of the vasculature, whose development coincides with onset of bleeding with asymptomatic presentation. The critical extend as a risk factor presents with symptom presentation and indication of brain damage development. Early vasospasm treatment is a priority in prevention of brain ischemia and disability. Existing methods of vasospasm treatment are conservative, endovascular and combined, with simultaneous intraarterial vasodilator application. The aim of this study is to determine whether intraarterial application of Calcium- blocker Nimodipine will generate immediate vasodilation, facilitating endovascular aneurism treatment, resulting in long term resolution of the condition. Fifteen patients with SAH received endovascular treatment in the first 48 hours of hemorrhage onset, with consequent intraarterial Nimodipine application if vasospasm was detected. All patients had ruptured aneurism of anterior circulation. Vessel diameter was measured before and after Nimodipine application. The occurrence and degree of vasodilation, as a difference between both diameters, were considered a confirmation of drug effectiveness.&nbsp;&nbsp;Complete spasm relief occurred in 10 patients, residual vasospasm persisted in 4 patients, no VS relief occurred in 1 patient.&nbsp;&nbsp;Intraarterial Nimodipine application during endovascular brain aneurism treatment effectively relieves vasospasm. Early coiling reduces complication risks and development of post ischemic brain damage. Key words: Vasospasm, SAH, Nimodipine, Intraarterial, endovascular treatment. &nbsp;&nbsp;&nbsp;&nbsp;

Understanding the role of miRNAs in the pathogenesis of brain arteriovenous malformations

Brain arteriovenous malformations (AVMs) are abnormal vessels that are prone to rupture, causing life-threatening intracerebral hemorrhage (ICH). Understanding the molecular basis of pathogenesis, timely diagnosis, and treatment of brain AVMs are some of the urgent problems in neurosurgery. MicroRNAs (miRNAs) are small endogenous RNAs that regulate gene-expression posttranscriptionally. MiRNAs are involved in almost all biological processes, including cell proliferation, apoptosis, and cell differentiation. Recent studies have shown that miRNAs can be involved in brain AVMs formation and rupture. There are also extracellular forms of miRNAs. Circulating miRNAs have been detected in the blood circulation and other body fluids. Owing to their stability and resistance to endogenous RNase activity, circulating miRNAs have been proposed as diagnostic and prognostic biomarkers for various diseases, such as tumors, cardiovascular and autoimmune diseases. In this review, we summarized the role of some miRNAs in brain AVMs pathogenesis and discussed their potential clinical application as non-invasive biomarkers.

Relationship between the features of venous drainage of supratentorial arteriovenous malformations and the risk of intracranial hemorrhage

Intracranial hemorrhage is the most common complication of cerebral arteriovenous malformations (AVM). In recent years, most studies devoted to the features of AVM functioning consider venous drainage as important factor influencing the rupture of malformation. To review the literature data on the relationship between the features of venous drainage of cerebral arteriovenous malformations and intracranial hemorrhage. We found 43 studies discussing the features of AVM venous drainage for the period from 1982 to 2020. Most of reports were published between 2005 and 2020. Deep venous drainage and a single drainage vein were the most significant factors influencing the risk of hemorrhage. Venous ectasia, reflux, stenosis, number, length and tortuosity of drainage veins were less important for the risk of AVM rupture. Analysis of the features of AVM venous drainage can make it possible to predict the natural course of disease and risk of intracranial hemorrhage. These aspects are essential for neurosurgical treatment.

Venous tortuosity as a novel biomarker of rupture risk in arteriovenous malformations: ARI score

BackgroundRisk of rupture in arteriovenous malformations (AVMs) varies considerably among series. Hemodynamic factors, especially within the venous side of the circuit, seem to be responsible but are not yet well...

Image Characteristicộng sự of Ruptured Arteriovenous Malformations of the Brain on the Multislice Computed Tomography

This study describes the features of the image of the Ruptures Brain Arteriovenous Malformation (AVM) based on films of Multislide Computed Tomography (MSCT) at Bach Mai Hospital. The study used descriptive cross-sectional, prospective and retrospective method to analyze the MSCTs of 40 patients at the Center of Radiology, Bach Mai Hospital, from March 2019 to March 2020. The results show that the common age of the patients was &lt;40 years old and the average age was 33.88 ± 16.27; the ratio of female/male was ≈ 1.11/1; 70% of the patients suffered from headache. On admission, 52.5% of the patients were conscious (glassgow 15 points), 30% of them lost consciousness (glassgow &lt;13 points) and 17.5% were comatose; 47.5% had a syndrome of increased intracranial pressure; 22.5% with detected cerebral AVM but never treated; 77.5% with ruptured cerebral AVM in the upper floor of the cerebellum and 57.5% had it in the highly functional area; 67.5% with cerebral AVM ≤ 3cm in size. Feeding artery ≤ 3 stalks accounted for 85%, of which 1 stem accounted for the majority. Attached aneurysm accounted for 42.5%, mainly in AVM drive aneurysm (32.5%). Pure shallow drainage veins accounted for 50%. Brain parenchymal hemorrhage alone accounted for 60%. Brain parenchymal with ventricular and subarachnoid hemorrhage accounted for 37.5%. The small size hemorrhage volume ratio (&lt;30 mm) and the average size (30-60 mm) accounted for the same percentage of 45%. According to the Spetzler - Martin classification, the cerebral ruptured venous malformation drive with low resolution (I-III) accounted for 85%. Overall, MSCT provides information to help guide the treatment of cerebral hemorrhage caused by cerebral AVM.&#x0D; Keywords:&#x0D; Arteriovenous malformation of the brain, ruptured cerebral arteriovenous malformations, Multislide Computed Tomography (MSCT).&#x0D; References&#x0D; [1] R. M. Friedlander, Clinical Practice, Arteriovenous Malformations of the Brain, N Engl J Med, Vol. 356, No. 26, 2007, pp. 2704-2712, https://doi.org/10.1056/nejmcp067192.[2] J. F. Yu, A. D. Nicholson, J. Nelson et al., Predictors of Intracranial Hemorrhage Volume and Distribution in Brain Arteriovenous Malformation, Vol. 24, No. 2, 2018, pp. 183-188, https://doi.org/10.1177/1591019917749819.[3] E. Shotar, M. Debarre, N. A. Sourour et al., Retrospective Study of Long-term Outcome after Brain Arteriovenous Malformation Rupture: the RAP Score, J Neurosurg, Vol. 128, No. 1, 2018, pp. 78-85, https://doi.org/10.3171/2016.9.jns161431.[4] P. M. Thong, N. H. An, The Initial Results of Treatment Mass the Brain Arteriovenous Malformation Rupture with Surgery in Combination with Embolization in Bach Mai Hospital; Vietnam Journal of Medicine, October, No. 1, 2017, pp. 51-56 (in Vietnames). [5] R. F. Speizler, N. A. Martin, A Proposed Grading System for Arteriovenous Malformations, J Neurosurg, Vol. 108, No. 1, 2008, pp. 186-193, https://doi.org/10.3171/jns/2008/108/01/0186[6] M. Majumdar, L. A. Tan, M. Chen, Critical Assessment of the Morbidity Associated with Ruptured Cerebral Arteriovenous Malformations, J Neurointerv Surg, Vol. 8, No. 2, 2016, pp. 163-167, https://doi.org/10.1136/neurintsurg-2014-011517. [7] R. F. Spetzler, D. S. Kondziolka, R. T. Higashida et al., Comprehensive Management of Arteriovenous Malformation of the Brain and Spine, Cambridge University Press, 2015, pp. 78-85, https://doi.org/10.1080/01616412.1998.11740583[8] R. Torné, R. A. Hernández, F. Arikan et al., Posterior Fossa Arteriovenous Malformations: Significance of Higher incidence of Bleeding and Hydrocephalus, Clin Neurol Neurosurg, Vol. 134, 2015, pp. 37-43, https://doi.org/10.1016/j.clineuro.2015.04.003.

Quantitative evaluation of hemodynamics after partial embolization of brain arteriovenous malformations

BackgroundTo explore the hemodynamic changes after embolization of arteriovenous malformations (AVMs) using quantitative digital subtraction angiography (QDSA).MethodsWe reviewed 74 supratentorial AVMs that underwent endovascular embolization and performed a quantitative hemodynamic...

Profile of the brain arteriovenous malformation at National Brain Center hospital in 2015 – 2016: Epidemiological study

Introduction: Brain arteriovenous malformation (AVM) is a congenital vascular lesion in which arterial blood flows directly into draining veins without capillary networking. The estimated incidence rate is approximately 1 case for 100,000 people a year. Clinical presentations are headache, seizure, neurological deficit, and others that are caused by space-occupying lesions. The treatment of brain AVM consists of microsurgery resection, embolization, stereotactic radiosurgery to conservative treatment.Methods: The design of the study was a descriptive non-analytical study. Data were taken from patients' medical records, radiological records, and catheter lab data records at National Brain Center Hospital in 2015 – 2016.Results: There were 32 patients with AVM. The characteristics of brain AVM in our study were mostly men (62.5%), productive age ranging from 20 – 29 years (31.25%), manifested as seizure (43.75%), presence with Glasgow Coma Scale (GCS) score 15 (87.5%), and rupture of brain AVM nidus (59.38%).Conclusion: Brain AVM predominantly occurred at a young age and the management varied on the Spetzler-Martin grading. In addition, the likelihood of rupture was influenced by the characteristics of the lesion, such as size, age, location of the nidus, and history of rupture of brain AVM nidus.Keywords: brain arteriovenous malformation, epidemiology, profile

Factors associated with seizures at initial presentation in pediatric patients with cerebral arteriovenous malformations.

Children with cerebral arteriovenous malformations (AVMs) can present with seizures, potentially increasing morbidity and impacting clinical management. However, the factors that lead to seizures as a presenting sign are not well defined. While AVM-related seizures have been described in case series, most studies have focused on adults and have included patients who developed seizures after an AVM rupture. To address this, the authors sought to analyze demographic and morphological characteristics of AVMs in a large cohort of children. The demographic, clinical, and AVM morphological characteristics of 189 pediatric patients from a single-center database were studied. Univariate and multivariate logistic regression models were used to test the effect of these characteristics on seizures as an initial presenting symptom in patients with unruptured brain AVMs. Overall, 28 of 189 patients initially presented with seizures (14.8%). By univariate comparison, frontal lobe location (p = 0.02), larger AVM size (p = 0.003), older patient age (p = 0.04), and the Supplemented Spetzler-Martin (Supp-SM) grade (0.0006) were associated with seizure presentation. Multivariate analysis confirmed an independent effect of frontal lobe AVM location and higher Supp-SM grade. All patients presenting with seizures had AVMs in the cortex or subcortical white matter. While children and adults share some risk factors for seizure presentation, their risk factor profiles do not entirely overlap. Pediatric patients with cortical AVMs in the frontal lobe were more likely to present with seizures. Additionally, the Supp-SM grade was highly associated with seizure presentation. Future clinical research should focus on the effect of therapeutic interventions targeting AVMs on seizure control in these patients.