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Risk factors of hematomyelia recurrence and clinical outcome in children with intradural spinal cord arteriovenous malformations.
AJNR Am J Neuroradiol. 2014 Jul; 35(7):1440-6.AA

Abstract

BACKGROUND AND PURPOSE

Few published data are available concerning the risk of re-bleeding of spinal cord AVM after an hematomyelia and concerning the long-term clinical outcome. Our aim was to assess the risk of recurrence and long-term clinical outcome after hematomyelia in children with spinal cord AVMs.

MATERIALS AND METHODS

This single-center retrospective study reviewed the clinical and radiologic data of 28 children younger than 18 years of age with arteriovenous malformation who had experienced at least 1 episode of hematomyelia between 1988 and 2012. Long-term clinical outcome was assessed by the American Spinal Injury Association Impairment Scale, and radiologic review included MR imaging and angioarchitecture on angiography (blinded to clinical information) before treatment and at recurrence.

RESULTS

Sixteen children (57%) experienced 1 episode of hematomyelia, while 12 children (43%) experienced recurrence. Girls and boys were equally affected (sex ratio, 1:1), and mean clinical follow-up was 5.7 ± 4.4 years. The risk of recurrence was higher for AVMs of the cervical and upper thoracic spine, 12 (100%) versus 11 (69%) (P = .01). A high American Spinal Injury Association scale score at last follow-up was reported for 11 children (39%), and the risk of recurrence tended to be associated with poorer functional prognosis (7 [64%] versus 5 [29%], P = .07). At the time of recurrence, perimedullary venous drainage was the main factor associated with recurrence (P = .002). Occlusion rate ≥50% was associated with a decreased risk of recurrence (P = .047).

CONCLUSIONS

In the present series, cervical and upper thoracic spinal cord AVMs and microarchitecture were predictive of the risk of hematomyelia recurrence. Perimedullary venous drainage was one of the main parameters associated with recurrence. Functional prognosis was better in patients with a single episode of hematomyelia.

Authors+Show Affiliations

From the Service de Neuroradiologie (G.S., M.S., D.D., A.O.) guillaume.saliou@bct.aphp.fr.Service de Neurologie Pédiatrique (A.T., M. Tardieu, K.D.).Service de Neurologie (M. Theaudin), Centre Hospitalier Universitaire Bicêtre, National Referral Center for Neurovascular Malformations in Children, Le Kremlin Bicêtre Cedex, France.Service de Neurologie Pédiatrique (A.T., M. Tardieu, K.D.).From the Service de Neuroradiologie (G.S., M.S., D.D., A.O.).From the Service de Neuroradiologie (G.S., M.S., D.D., A.O.).From the Service de Neuroradiologie (G.S., M.S., D.D., A.O.).Service de Neurologie Pédiatrique (A.T., M. Tardieu, K.D.).

Pub Type(s)

Clinical Trial
Journal Article

Language

eng

PubMed ID

24627450

Citation

Saliou, G, et al. "Risk Factors of Hematomyelia Recurrence and Clinical Outcome in Children With Intradural Spinal Cord Arteriovenous Malformations." AJNR. American Journal of Neuroradiology, vol. 35, no. 7, 2014, pp. 1440-6.
Saliou G, Tej A, Theaudin M, et al. Risk factors of hematomyelia recurrence and clinical outcome in children with intradural spinal cord arteriovenous malformations. AJNR Am J Neuroradiol. 2014;35(7):1440-6.
Saliou, G., Tej, A., Theaudin, M., Tardieu, M., Ozanne, A., Sachet, M., Ducreux, D., & Deiva, K. (2014). Risk factors of hematomyelia recurrence and clinical outcome in children with intradural spinal cord arteriovenous malformations. AJNR. American Journal of Neuroradiology, 35(7), 1440-6. https://doi.org/10.3174/ajnr.A3888
Saliou G, et al. Risk Factors of Hematomyelia Recurrence and Clinical Outcome in Children With Intradural Spinal Cord Arteriovenous Malformations. AJNR Am J Neuroradiol. 2014;35(7):1440-6. PubMed PMID: 24627450.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Risk factors of hematomyelia recurrence and clinical outcome in children with intradural spinal cord arteriovenous malformations. AU - Saliou,G, AU - Tej,A, AU - Theaudin,M, AU - Tardieu,M, AU - Ozanne,A, AU - Sachet,M, AU - Ducreux,D, AU - Deiva,K, Y1 - 2014/03/13/ PY - 2014/3/15/entrez PY - 2014/3/15/pubmed PY - 2015/3/31/medline SP - 1440 EP - 6 JF - AJNR. American journal of neuroradiology JO - AJNR Am J Neuroradiol VL - 35 IS - 7 N2 - BACKGROUND AND PURPOSE: Few published data are available concerning the risk of re-bleeding of spinal cord AVM after an hematomyelia and concerning the long-term clinical outcome. Our aim was to assess the risk of recurrence and long-term clinical outcome after hematomyelia in children with spinal cord AVMs. MATERIALS AND METHODS: This single-center retrospective study reviewed the clinical and radiologic data of 28 children younger than 18 years of age with arteriovenous malformation who had experienced at least 1 episode of hematomyelia between 1988 and 2012. Long-term clinical outcome was assessed by the American Spinal Injury Association Impairment Scale, and radiologic review included MR imaging and angioarchitecture on angiography (blinded to clinical information) before treatment and at recurrence. RESULTS: Sixteen children (57%) experienced 1 episode of hematomyelia, while 12 children (43%) experienced recurrence. Girls and boys were equally affected (sex ratio, 1:1), and mean clinical follow-up was 5.7 ± 4.4 years. The risk of recurrence was higher for AVMs of the cervical and upper thoracic spine, 12 (100%) versus 11 (69%) (P = .01). A high American Spinal Injury Association scale score at last follow-up was reported for 11 children (39%), and the risk of recurrence tended to be associated with poorer functional prognosis (7 [64%] versus 5 [29%], P = .07). At the time of recurrence, perimedullary venous drainage was the main factor associated with recurrence (P = .002). Occlusion rate ≥50% was associated with a decreased risk of recurrence (P = .047). CONCLUSIONS: In the present series, cervical and upper thoracic spinal cord AVMs and microarchitecture were predictive of the risk of hematomyelia recurrence. Perimedullary venous drainage was one of the main parameters associated with recurrence. Functional prognosis was better in patients with a single episode of hematomyelia. SN - 1936-959X UR - https://www.unboundmedicine.com/medline/citation/24627450/Risk_factors_of_hematomyelia_recurrence_and_clinical_outcome_in_children_with_intradural_spinal_cord_arteriovenous_malformations_ L2 - http://www.ajnr.org/cgi/pmidlookup?view=long&pmid=24627450 DB - PRIME DP - Unbound Medicine ER -