Angioarchitecture and prognosis of pediatric intracranial pial arteriovenous fistula.

OBJECTIVE: Pial arteriovenous fistulas (PAVFs) are rare and mostly observed in children. However, the overall angioarchitecture, clinical features, treatments and long-term prognosis for pediatric patients remain unclear. METHODS: Clinical data of consecutive 42 pediatric PAVFs were documented and analysed. According to the differences of age distribution and clinical features, they were split into a younger group (≤3 years old; 20 cases) and an older group (3-14 years old; 22 cases). RESULTS: Their mean age was 4.9±3.9 years, and the mean preoperative modified Rankin Scale (mRS) score was 1.64±1.57. Fourteen patients (33.3%) were asymptomatic, followed by epilepsy (21.4%), intracranial haemorrhage (16.7%), hydrocephalus (9.5%), developmental delay (7.1%), intermittent headache (7.1%) and congestive heart failure (4.8%). Annual bleeding rate and rebleeding rate before treatment reached 3.86% and 3.17%. Poor venous drainage including sinus dynamic obstruction (21 cases, 50.0%) and sinus occlusion (17 cases, 40.48%) were found with high frequency among these patients. Finally, 33 cases were cured (78.57%), and 4 cases faced surgery-related complications (9.52%). During 24-140 months' follow-up, the mean mRS score reduced to 0.57±0.40. However, only 22 cases (52.38%) recovered to absolutely normal, and poor venous drainage was the risk factor for patients' incomplete recovery (p=0.028, Exp(B)=14.692, 95% CI 1.346 to 160.392). Compared with the older group, younger group showed more chronic symptoms, more secondary pathological changes, more times treatment and worse prognosis (p=0.013, 0.002, 0.000 and 0.032, respectively). CONCLUSIONS: Pediatric PAVF has different angioarchitectures, clinical features and prognoses in different age groups. Poor venous drainage is an important factor leading to poor prognosis, and it accounts for incomplete recovery in nearly half of patients.

Multimodality Treatment of Deep-seated Cerebral Arteriovenous Malformations: The Experiences of One Center.

OBJECTIVE: Treatment of deep-seated cerebral arteriovenous malformations (AVMs) remains challenging for neurosurgeons or neuroradiologists. This study aims to review the experiences of one center in using multimodality treatment for deep-seated AVMs. METHODS: The AVM database of Xuanwu Hospital, Capital Medical University was searched, and 96 patients who were diagnosed with a deep-seated cerebral AVM between 2010 and 2020 were identified. The following information was collected and analyzed: patients' clinical features, treatment modality used, posttreatment complications, AVM obliteration rate, rebleeding rate, and functional outcome during follow-up. The patients' posttreatment modified Rankin scale (mRS) scores were split into two groups: good outcome (mRS score ≤ 2) and poor outcome (mRS score ≥ 3). Univariate and multivariate logistic regression analyses were applied to test the predictors of clinical outcomes and AVM obliteration. RESULTS: Eighty-eight out of 96 patients (91.7%) presented with initial hemorrhaging. The pretreatment mRS score was ≤ 2 in 80 patients (88.3%) patients and ≥ 3 in 16 patients (16.7%). Limb weakness was present in 42 patients (43.8%). In this sample, 210 hemorrhages occurred during 2056 person-years before diagnosis, yielding an annual hemorrhage rate of 10.2% per person-year. Angiographic obliteration was achieved in 29 patients (30.2%). At the last follow-up, 80 patients (83.3%) had good clinical outcomes, whereas 16 (16.7%) had a deterioration in their clinical presentation following treatment. Multivariate analyses indicated that pretreatment limb weaknesses and a high Spetzler-Martin grade predicted poor clinical outcomes (P = 0.003 and 0.008, respectively). Fewer feeding arteries were a predictor for AVM obliteration (P = 0.034). CONCLUSION: Good outcomes can be achieved through multimodal treatment of deep-seated AVMs. A single supplying artery is a predictor of AVM obliteration. Pretreatment limb weaknesses and high Spetzler-Martin grades predict poor clinical outcomes.