Abstract Background and aims Brain arteriovenous malformation (bAVM) rupture is the leading cause of intracranial hemorrhage (ICH) in pediatric patients and its management remains challenging. This study investigates treatment complications, re-rupture and mortality to provide insights in management and outcomes in the pediatric population. Methods Pediatric patients (18 years) presenting with bAVM rupture between 2007 and 2024 were retrospectively identified from the Amsterdam University Medical Center Database. Patients undergoing treatment or conservative management were included. Demographics, AVM and treatment characteristics were collected. Obliteration rate, intra- and post-procedural complications (eg, hemorrhagic and ischemic) and overall mortality were evaluated. Additionally, pre- and post-intervention re-rupture was assessed. Results Among 41 pediatric patients presenting with ICH, (median age 11.8 years, IQR 5.4-14.7; 17 female), most AVMs were small (3 cm, 83%) and predominantly Spetzler-Martin grade II-III (68%). Treatment included embolization (41.5%), microsurgery (17.1%), stereotactic radiosurgery (7.3%), multimodal intervention (24.4%), or no intervention (9.8%). Complete obliteration was achieved in 64.9% of treated patients, 35.1% was partially treated. In this high-risk cohort, treatment complications occurred in 7 patients (17.1%), including 4 hemorrhagic events. Over a median follow-up period of 63 months (IQR 22-128), re-rupture occurred in 4 patients (9.8%), including 3 following partial treatment and 1 prior to intervention. Overall mortality was 4 patients (9.8%), with 2 deaths attributable to the initial hemorrhage. Conclusions In this complex pediatric cohort with ruptured bAVMs, treatment complications and mortality remained within previously reported ranges. Re-rupture remains clinically relevant, underscoring the need for future investigation in larger cohorts to better contextualize outcomes across AVM and treatment subgroups. Conflict of interest Janneke C. Burger: Nothing to disclose, René van den Berg: Nothing to disclose, Ivar O. Kommers: Nothing to disclose, Mervyn D.I. Vergouwen: Nothing to disclose, Jonathan M. Coutinho: Nothing to disclose, Dagmar Verbaan: Nothing to disclose, Irene C. van der Schaaf: Nothing to disclose, Bart J. Emmer: Nothing to disclose.
Burger et al. (Fri,) studied this question.