Outcomes of multimodality therapy in pediatric patients with ruptured and unruptured brain arteriovenous malformations

John D. Nerva, Louis J. Kim, Jason Barber, Jason K. Rockhill, Danial K. Hallam, Basavaraj V. Ghodke, Laligam N. Sekhar*

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

28 Citations (Scopus)


Background: Brain arteriovenous malformations (BAVMs) are a frequent cause of pediatric hemorrhagic stroke, which frequently results in significant morbidity and mortality. 
Objective: To analyze the results of multimodality treatment for a consecutive series of pediatric patients with ruptured and unruptured BAVMs at a single institution. 
Methods: Forty patients <18 years of age were retrospectively reviewed. Results were divided by hemorrhage status, ie, ruptured or unruptured, and the intended curative treatment modality, ie, surgical resection or stereotactic radiosurgery. 
Results: Twenty-seven patients (68%) presented with hemorrhage, and 13 patients (32%) presented without hemorrhage. Among ruptured patients, 19 (70%) underwent surgery and 8 (30%) underwent stereotactic radiosurgery. In surviving patients who presented with hemorrhage, 23 of 26 (88%) had a modified Rankin Scale (mRS) score of 0 to 2 at the last follow-up, and 24 of 26 (92%) obtained radiographic cure. For unruptured BAVMs, all 6 patients with grade I to III BAVM obtained radiographic cure and had an mRS score of 0 to 1 at the last follow-up, whereas 1 of 5 patients (20%) with grade IV and V BAVM had BAVM obliteration and a mean mRS score of 1.8 at the last follow-up. In a total of 93.6 years of follow-up from date of presentation to last clinical follow-up, there was 1 hemorrhage (1.1%/y). Of 30 patients with radiographic obliteration, 2 patients had radiographic recurrence (7% incidence). 
Conclusion: The majority of ruptured patients had an mRS score of 0 to 2 at the last follow-up and obtained radiographic cure. Unruptured patients with grade I to III BAVMs had superior outcomes compared with those with grade IV and V AVMs. Treatment of grade I to III BAVMs appears safe, and additional study is needed to determine optimal strategies for the management of unruptured grade IV and V BAVMs. Abbreviations: ARUBA, A Randomized Trial of Unruptured Brain Arteriovenous Malformations BAVM, brain arteriovenous malformation RBAS, radiosurgery-based brain arteriovenous malformation grading system mRS, modified Rankin Scale SAIVM, Scottish Audit of Intracranial Vascular Malformations SRS, stereotactic radiosurgery WFNS, World Federation of Neurosurgical Societies.
Original languageEnglish
Pages (from-to)695-706
Number of pages12
Issue number5
Publication statusPublished - 1 May 2016
Externally publishedYes


  • brain arteriovenous malformations
  • clinical outcome
  • microsurgical resection
  • stereotactic radiosurgery
  • pediatrics


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