Hydrocephalus in children with ruptured cerebral arteriovenous malformation

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  • 1 APHP, Necker Hospital, Université de Paris;
  • 2 Department of Neuroradiology, INSERM U1266;
  • 3 Imagine Institute, INSERM U1163; and
  • 4 Interventional Neuroradiology Centre Hospitalier Sainte-Anne, Paris, France
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OBJECTIVE

Hydrocephalus is a strong determinant of poor neurological outcome after intracerebral hemorrhage (ICH). In children, ruptured brain arteriovenous malformations (bAVMs) are the dominant cause of ICH. In a large prospective cohort of pediatric patients with ruptured bAVMs, the authors analyzed the rates and predictive factors of hydrocephalus requiring acute external ventricular drainage (EVD) or ventriculoperitoneal shunt (VPS).

METHODS

The authors performed a single-center retrospective analysis of the data from a prospectively maintained database of children admitted for a ruptured bAVM since 2002. Admission clinical and imaging predictors of EVD and VPS placement were analyzed using univariate and multivariate statistical models.

RESULTS

Among 114 patients (mean age 9.8 years) with 125 distinct ICHs due to ruptured bAVM, EVD and VPS were placed for 55/125 (44%) hemorrhagic events and 5/114 patients (4.4%), respectively. A multivariate nominal logistic regression model identified low initial Glasgow Coma Scale (iGCS) score, hydrocephalus on initial CT scan, the presence of intraventicular hemorrhage (IVH), and higher modified Graeb Scale (mGS) score as strongly associated with subsequent need for EVD (all p < 0.001). All children who needed a VPS had initial hydrocephalus requiring EVD and tended to have higher mGS scores.

CONCLUSIONS

In a large cohort of pediatric patients with ruptured bAVM, almost half of the patients required EVD and 4.4% required permanent VPS. Use of a low iGCS score and a semiquantitative mGS score as indicators of the IVH burden may be helpful for decision making in the emergency setting and thus improve treatment.

ABBREVIATIONS AUC = area under the curve; bAVM = brain arteriovenous malformation; EVD = external ventricular drainage; ICH = intracerebral hemorrhage; iGCS = initial Glascow Coma Scale; IVH = intraventricular hemorrhage; KOSCHI = King’s Outcome Scale for Childhood Head Injury; mGS = modified Graeb Scale; VPS = ventriculoperitoneal shunt.

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Contributor Notes

Correspondence Thomas Blauwblomme: Necker Hospital, Université de Paris, France. thomas.blauwblomme@aphp.fr.

INCLUDE WHEN CITING Published online May 22, 2020; DOI: 10.3171/2020.3.PEDS19680.

S.S. and G.B. contributed equally to this work.

Disclosures The authors report no conflict of interest concerning the materials or methods used in this study or the findings specified in this paper.

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