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. 2023 Sep;39(9):2439-2447.
doi: 10.1007/s00381-023-05954-9. Epub 2023 May 18.

Multi-modality treatment approach for paediatric AVMs with quality-of-life outcome measures

Natasha Aziz  1 , John C Duddy  2 , Danial Saeed  3 , Dawn Hennigan  2 , Anil Israni  4 , Mani Puthuran  3 , Arun Chandran  3 , Conor Mallucci  2
Affiliations

Multi-modality treatment approach for paediatric AVMs with quality-of-life outcome measures

Natasha Aziz et al. Childs Nerv Syst. 2023 Sep.

Abstract

Purpose: Despite the potentially devastating and permanently disabling effects of paediatric arteriovenous malformations (pAVMs), there is a paucity of studies reporting long-term quality-of-life (QoL) outcomes in AVM patients. We aim to evaluate the management strategies for paediatric intracranial pAVMs in the UK and long-term QoL outcomes using a validated paediatric quality-of-life outcome measure.

Methods: In this single-centre case-series, we retrospectively reviewed a prospectively maintained database of all paediatric patients (i.e. 0-18 years old) with intracranial AVMs, who were managed at Alder Hey Children's Hospital from July 2007 to December 2021. We also collected the PedsQL 4.0 score for these patients as a measure of QoL.

Results: Fifty-two AVMs were included in our analysis. Forty (80%) were ruptured, 8 (16%) required emergency intervention, 17 (35%) required elective surgery, 15 (30%) underwent endovascular embolisation, and 15 (30%) patients underwent stereotactic radiosurgery. There was an 88% overall obliteration rate. Two (4%) pAVMs rebled, and there were no mortalities. Overall, the mean time from diagnosis to definitive treatment was 144 days (median 119; range 0-586). QoL outcomes were collected for 26 (51%) patients. Ruptured pAVM presentation was associated with worse QoL (p = 0.0008). Location impacted psychosocial scores significantly (71.4, 56.9, and 46.6 for right supratentorial, left supratentorial, and infratentorial, respectively; p = 0.04).

Conclusion: This study shows a staged multi-modality treatment approach to pAVMs is safe and effective, with superior obliteration rates with surgery alone. QoL scores are impacted by AVM presentation and location regardless of treatment modality.

Keywords: AVM; Arteriovenous malformations; Children; Multimodal management; Quality-of-life.

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