1321. Pediatric Intracranial Arteriovenous Malformations: Examining Rehabilitation Outcomes

Authors: Melissa Ann LoPresti, MD; Melissa LoPresti, MD; Nisha Giridharan, MD; Monika Pyarali, BS; Nisha Gadgil, MD; Peter Kan, MD, MPH; Christian Niedzwiekci, MD; Sandi Lam (Houston, TX)

Introduction:

Arteriovenous malformations (AVMs), a common cause of pediatric intracranial hemorrhage, can rupture leading to debilitating neurological injury.  We aimed to examine our experience with pediatric intracranial AVMs as they relate to functional and rehabilitation outcomes.

Methods:

A retrospective chart review was performed, examining all cases of intracranial AVMs in patients age 0-18, treated between 2005-2018, at our institution. Those that participated in inpatient rehabilitation in conjunction with AVM treatment were reviewed to explore preoperative assessment, AVM characteristics, treatment and postoperative functional and rehabilitation outcomes.

Results:

14 of 105 patients identified had participated in inpatient rehabilitation. 64.3% underwent surgical treatment, 14.3% treated conservatively, and 21.4% were treated surgically at an outside facility prior to transitioning to our institution. Lower grade AVMs were more commonly treated surgically, while higher grade AVMs were more commonly treated conservatively. 75% treated surgically were radiographically cured; none conservatively treated experienced radiographic cure.  Postoperative complications included hemorrhage, paresis, infection, bone resorption, hydrocephalus, and seizures, among others. Inpatient rehabilitation admissions occurred after AVM treatment, apart from one case treated after rupture, before treatment.

Rehabilitation outcomes showed improvement in all measures.  Self-Care Score improved by 16.3, 10, and 13.3 points in those treated surgically, conservatively and at an outside facility, respectively. Mobility Scores improved by 10.8, 5, and 8 points, while Cognitive Scores improved by 14.3, 1.5, and 4.3 points, respectively.  Average change in the Functional Independence Measure for Children (WeeFIM) was 36.7, 16.5, and 25.7 in those treated surgically, conservatively and at an outside facility.  WeeFIM efficacy was 1.78 on average.

Conclusion:

To our knowledge, this is the first series exploring pediatric intracranial AVMs and rehabilitation outcomes. We present a cohort of patients who have undergone inpatient rehabilitation related to AVM rupture or surgery and experienced improvement across all rehabilitation disciplines.