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

Autor: Aziz N; School of Medicine, University of Liverpool, Liverpool, UK. natasha.aziz@doctors.net.uk., Duddy JC; Department of Neurosurgery, AlderHey Children's NHS Foundation Trust, Liverpool, UK., Saeed D; Department of Neuroradiology, The Walton Centre NHS Foundation Trust, Liverpool, UK., Hennigan D; Department of Neurosurgery, AlderHey Children's NHS Foundation Trust, Liverpool, UK., Israni A; Department of Neurology, AlderHey Children's NHS Foundation Trust, Liverpool, UK., Puthuran M; Department of Neuroradiology, The Walton Centre NHS Foundation Trust, Liverpool, UK., Chandran A; Department of Neuroradiology, The Walton Centre NHS Foundation Trust, Liverpool, UK., Mallucci C; Department of Neurosurgery, AlderHey Children's NHS Foundation Trust, Liverpool, UK.
Jazyk: angličtina
Zdroj: Child's nervous system : ChNS : official journal of the International Society for Pediatric Neurosurgery [Childs Nerv Syst] 2023 Sep; Vol. 39 (9), pp. 2439-2447. Date of Electronic Publication: 2023 May 18.
DOI: 10.1007/s00381-023-05954-9
Abstrakt: 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.
(© 2023. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)
Databáze: MEDLINE
Externí odkaz: