Pediatric intracranial arteriovenous malformations: Examining rehabilitation outcomes

Article type: Research Article

Authors: LoPresti, Melissa A.^a | Giridharan, Nisha^a | Pyarali, Monika^a | Gadgil, Nisha^a | Kan, Peter T.^a | Niedwiekci, Christian^b | Lam, Sandi K.^{c; *}

Affiliations: [a] Division of Pediatric Neurosurgery, Texas Children’s Hospital, Department of Neurosurgery, Baylor College of Medicine, Houston, TX, USA | [b] Department of Physical Medicine and Rehabilitation, Texas Children’s Hospital, Houston, TX, USA | [c] Division of Pediatric Neurosurgery, Lurie Children’s Hospital, Department of Neurosurgery, Northwestern University, Chicago, IL, USA

Correspondence: [*] Corresponding author: Sandi Lam, Division Chief, Division of Pediatric Neurosurgery, Lurie Children’s Hospital, Professor, Department of Neurosurgery, Northwestern University Feinberg School of Medicine, 225 E Chicago Ave, Box 28, Chicago, IL 60611, USA. E-mail: [email protected];[email protected].

Abstract: PURPOSE: Arteriovenous malformation (AVM) rupture in children can cause debilitating neurological injury. Rehabilitation is key to recovery, though literature details little regarding rehabilitation outcomes. We examined a single-center experience with pediatric AVMs as related to acute inpatient rehabilitation outcomes. METHODS: At our institution, a retrospective chart review was completed examining all cases of intracranial AVMs in patients age 18 and younger who completed our acute inpatient rehabilitation program between 2012–2018. Patient characteristics, clinical data, treatment modality, and functional outcomes were reviewed. RESULTS: 14 patients with AVMs underwent acute inpatient rehabilitation; nine (64.3%) treated surgically at our institution, two (14.3%) non-surgically at our institution, and three (21.4%) surgically at an outside facility prior to transitioning care at our institution. Eight (57.1%) were male, seven (50.0%) Caucasian, and seven (50.0%) Hispanic. Seven (50.0%) presented with AVM rupture; six (42.9%) were found incidentally on imaging. Clinical courses, treatment outcomes, and post-treatment complications varied. Several patients underwent repeat treatment or additional procedures. Neurological deficits identified included hemiparesis, dystonia, spasticity, epilepsy, hydrocephalus, and ataxia. Inpatient rehabilitation unit length of stay was on average 21 days (SD 9.02, range 9–41). Functional Independence Measure for Children (WeeFIM®) scores, including self-care, mobility, and cognition, demonstrated improvement upon discharge. The mean total change was 36.7 points in those treated surgically, 16.5 in those treated non-surgically, and 25.7 in those treated surgically at another facility. CONCLUSION: We found that all pediatric patients with intracranial AVMs, across all treatment modalities, demonstrated improved outcomes across all functional domains after an acute inpatient rehabilitation program.

Keywords: Pediatric arteriovenous malformation, acute inpatient rehabilitation, outcomes, pediatric neurosurgery

DOI: 10.3233/PRM-190609

Journal: Journal of Pediatric Rehabilitation Medicine, vol. 13, no. 1, pp. 7-15, 2020