Brain Arteriovenous Malformation Recurrence After Apparent Microsurgical Cure: Increased Risk in Children Who Present With Arteriovenous Malformation Rupture

Alexander Copelan, Division of Neurointerventional Radiology, Department of Radiology and Biomedical Imaging (A.C., G.D., M.T.C., E.R.S., D.L.C., M.R.A., C.F.D., V.V.H., R.T.H., S.W.H.), University of California, San Francisco.
Gerald Drocton, Division of Neurointerventional Radiology, Department of Radiology and Biomedical Imaging (A.C., G.D., M.T.C., E.R.S., D.L.C., M.R.A., C.F.D., V.V.H., R.T.H., S.W.H.), University of California, San Francisco.
M Travis Caton, Division of Neurointerventional Radiology, Department of Radiology and Biomedical Imaging (A.C., G.D., M.T.C., E.R.S., D.L.C., M.R.A., C.F.D., V.V.H., R.T.H., S.W.H.), University of California, San Francisco.
Eric R. Smith, Division of Neurointerventional Radiology, Department of Radiology and Biomedical Imaging (A.C., G.D., M.T.C., E.R.S., D.L.C., M.R.A., C.F.D., V.V.H., R.T.H., S.W.H.), University of California, San Francisco.
Daniel L. Cooke, Division of Neurointerventional Radiology, Department of Radiology and Biomedical Imaging (A.C., G.D., M.T.C., E.R.S., D.L.C., M.R.A., C.F.D., V.V.H., R.T.H., S.W.H.), University of California, San Francisco.
Jeffrey Nelson, Center for Cerebrovascular Research (D.L.C., J.N., A.A.A., C.F., M.R.A., C.F.D., V.V.H., R.T.H., H.K., H.J.F., N.G., S.W.H.), University of California, San Francisco.
Adib A. Abla, Center for Cerebrovascular Research (D.L.C., J.N., A.A.A., C.F., M.R.A., C.F.D., V.V.H., R.T.H., H.K., H.J.F., N.G., S.W.H.), University of California, San Francisco.Follow
Christine Fox, Center for Cerebrovascular Research (D.L.C., J.N., A.A.A., C.F., M.R.A., C.F.D., V.V.H., R.T.H., H.K., H.J.F., N.G., S.W.H.), University of California, San Francisco.
Matthew R. Amans, Division of Neurointerventional Radiology, Department of Radiology and Biomedical Imaging (A.C., G.D., M.T.C., E.R.S., D.L.C., M.R.A., C.F.D., V.V.H., R.T.H., S.W.H.), University of California, San Francisco.
Christopher F. Dowd, Division of Neurointerventional Radiology, Department of Radiology and Biomedical Imaging (A.C., G.D., M.T.C., E.R.S., D.L.C., M.R.A., C.F.D., V.V.H., R.T.H., S.W.H.), University of California, San Francisco.
Van V. Halbach, Division of Neurointerventional Radiology, Department of Radiology and Biomedical Imaging (A.C., G.D., M.T.C., E.R.S., D.L.C., M.R.A., C.F.D., V.V.H., R.T.H., S.W.H.), University of California, San Francisco.
Randall T. Higashida, Division of Neurointerventional Radiology, Department of Radiology and Biomedical Imaging (A.C., G.D., M.T.C., E.R.S., D.L.C., M.R.A., C.F.D., V.V.H., R.T.H., S.W.H.), University of California, San Francisco.
Michael T. Lawton, Division of Pediatric Neurosurgery, Department of Neurological Surgery (N.G.), University of California, San Francisco.Follow
Helen Kim, Center for Cerebrovascular Research (D.L.C., J.N., A.A.A., C.F., M.R.A., C.F.D., V.V.H., R.T.H., H.K., H.J.F., N.G., S.W.H.), University of California, San Francisco.
Heather J. Fullerton, Center for Cerebrovascular Research (D.L.C., J.N., A.A.A., C.F., M.R.A., C.F.D., V.V.H., R.T.H., H.K., H.J.F., N.G., S.W.H.), University of California, San Francisco.
Nalin Gupta, Center for Cerebrovascular Research (D.L.C., J.N., A.A.A., C.F., M.R.A., C.F.D., V.V.H., R.T.H., H.K., H.J.F., N.G., S.W.H.), University of California, San Francisco.
Steven W. Hetts, Division of Neurointerventional Radiology, Department of Radiology and Biomedical Imaging (A.C., G.D., M.T.C., E.R.S., D.L.C., M.R.A., C.F.D., V.V.H., R.T.H., S.W.H.), University of California, San Francisco.

Document Type

Article

Abstract

BACKGROUND AND PURPOSE: Do children have an increased risk for brain arteriovenous malformation (AVM) recurrence compared with adults and does this risk vary depending on initial presentation with AVM rupture? METHODS: We retrospectively studied 115 patients initially presenting with brain AVM under age 25 years who underwent complete surgical resection of the AVM as documented by digital subtraction angiography (DSA) and had delayed follow-up DSA to evaluate for AVM recurrence after apparent initial cure. RESULTS: The mean time from baseline DSA to follow-up DSA was 2.3 years, ranging from 0 to 15 years. Twelve patients (10.4% of the 115 patient cohort and 16.7% of 72 patients with hemorrhage at initial presentation) demonstrated AVM recurrence on follow-up DSA. All patients with recurrence initially presented with intracranial hemorrhage, and intracranial hemorrhage was a significant predictor of recurrence (log rank =0.037). Among patients with initial hemorrhage, the 5-year recurrence rate was 17.8% (95% CI, 8.3%-35.7%). All recurrences occurred in patients who were children at the time of their initial presentation; the oldest was 15 years of age at the time of initial AVM surgery. The 5-year recurrence rate for children (0-18 years of age) with an initial presentation of hemorrhage was 21.4% (95% CI, 10.1%-41.9%). Using Cox regression, we found the risk of AVM recurrence decreased by 14% per each year increase in age at the time of initial surgical resection (hazard ratio=0.86 [95% CI, 0.75-0.99]; =0.031). CONCLUSIONS: There is a high rate of recurrence of apparently cured brain AVMs in children who initially present with AVM rupture. Imaging follow-up is warranted to prevent re-rupture.

Medical Subject Headings

Adolescent; Angiography, Digital Subtraction; Arteriovenous Fistula (diagnostic imaging, surgery); Brain (diagnostic imaging, surgery); Child; Child, Preschool; Female; Humans; Intracranial Arteriovenous Malformations (diagnostic imaging, surgery); Male; Microsurgery; Neurosurgical Procedures; Recurrence; Retrospective Studies; Rupture (surgery); Treatment Outcome; Young Adult

Publication Date

9-12-2020

Publication Title

Stroke

E-ISSN

1524-4628

Volume

51

Issue

10

First Page

2990

Last Page

2996

PubMed ID

32912090

Digital Object Identifier (DOI)

10.1161/STROKEAHA.120.030135

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