Long-term outcomes of ruptured cerebral arteriovenous malformations in the paediatric population: A retrospective review in a regional hospital in Hong Kong.

Affiliation

Division of Neurosurgery, Department of Surgery, Princes of Wales Hospital, The Chinese University of Hong Kong, Hong Kong. Electronic address: [Email]

Abstract

The objective of the study is to evaluate the management outcomes of ruptured cerebral arteriovenous malformations (bAVMs) in the paediatric population in a regional hospital in Hong Kong. We performed a retrospective review between 1 January 1999 and 31 December 2017 for ruptured bAVM in a regional neurosurgical centre in Hong Kong. All other vascular pathologies and unruptured cases were excluded. Thirty-three eligible patients were included for analysis. The median age at presentation was 12 (3-18), with a slight male preponderance. Presenting complaints included headache (60.6%), motor deficits (24.2%), and seizure (6.1%). Glasgow coma scale (GCS) on presentation (median, IQR) was 15 (13-15). bAVMs were lobar in 57.6%, infratentorial in 27.3%, and basal ganglia in 9.1%. Follow-up was 101 ± 61 months and ranged from 24 to 229 months. 12 (36.4%) patients underwent emergency haematoma evacuation with or without bAVM excision because of neurological deterioration in the acute phase. 7 (21.2%) patients underwent interval excision and 11(33.3%) patients underwent stereotactic radiosurgery (SRS). There was no residual bAVM and no Clavien-Dindo complications greater than grade II in interval surgery group. Those who underwent SRS had a significantly higher Spetzler-Martin grade; bAVM obliteration was achieved at 73.3%, without any major symptomatic post-radiosurgery complications. There was 1 (3%) mortality and 30 (90.9%) patients recovered well with minor non-disabling deficits (GOS 5). For paediatric patients with ruptured bAVM, a satisfactory management outcome can be achieved with careful patient selection for surgery and radiosurgery.

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