{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,1]],"date-time":"2026-09-01T22:18:25Z","timestamp":1788301105182,"version":"build-2803163510"},"reference-count":25,"publisher":"Journal of Neurosurgery Publishing Group (JNSPG)","issue":"5","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2023,5,1]]},"abstract":"<jats:sec>\n<jats:title>OBJECTIVE<\/jats:title>\n<jats:p>Patients with unruptured brain arteriovenous malformations (AVMs) may present with headaches, seizures, and\/or neurological deficits. A smaller number of cases may be discovered incidentally. These lesions remain incompletely understood due to their sparse reporting. Herein, the authors describe the largest series to date comparing the presentation, angioarchitecture, and management of incidental versus symptomatic unruptured AVMs in children.<\/jats:p>\n<\/jats:sec>\n<jats:sec>\n<jats:title>METHODS<\/jats:title>\n<jats:p>The authors performed a retrospective analysis of patients who presented with brain AVMs from 1998 to 2022 at the University of California, San Francisco. Inclusion criteria were age \u2264 18 years at the time of presentation and an angiographically proven unruptured AVM that had been diagnosed postnatally.<\/jats:p>\n<\/jats:sec>\n<jats:sec>\n<jats:title>RESULTS<\/jats:title>\n<jats:p>Of 76 children with unruptured AVMs, 66 (86.8%) presented with headaches, seizures, and\/or neurological deficit. Ten AVMs (13.1%) were incidentally discovered through unrelated disease workup (50%), cranial trauma (40%), or research study participation (10%). Compared with patients with symptomatic unruptured AVMs, patients with incidental unruptured AVMs had a smaller mean \u00b1 SD maximum nidus diameter (2.82 \u00b1 1.1 vs 3.98 \u00b1 1.52 cm, p = 0.025) and fewer had deep venous drainage (20% of patients vs 61%, p = 0.036). They also presented at an earlier age (10 \u00b1 5.2 vs 13.5 \u00b1 4 years, p = 0.043) and with longer duration to first treatment (541 \u00b1 922 vs 196 \u00b1 448 days, p = 0.005). During the observation period, 1 patient developed recurring headaches and demonstrated AVM nidus growth. Four AVMs greater than 3 cm in size or in a deep location were treated with radiosurgery. Six other AVMs were treated with resection, with 2 receiving preoperative embolization. Eight AVMs (80%) were obliterated on last follow-up. Postprocedural complications included 2 transient neurological deficits after resection and 1 case of delayed seizure development after radiosurgery. The mean follow-up period was 5.7 \u00b1 5.7 years without any hemorrhage episodes.<\/jats:p>\n<\/jats:sec>\n<jats:sec>\n<jats:title>CONCLUSIONS<\/jats:title>\n<jats:p>A substantial proportion of pediatric patients with unruptured AVMs are discovered incidentally. With earlier presentation and more elementary angioarchitecture than symptomatic unruptured AVMs, these incidental lesions provide a snapshot into the natural history of AVM before symptom development or rupture.<\/jats:p>\n<\/jats:sec>","DOI":"10.3171\/2023.1.peds22541","type":"journal-article","created":{"date-parts":[[2023,2,17]],"date-time":"2023-02-17T16:52:48Z","timestamp":1676652768000},"page":"463-468","source":"Crossref","is-referenced-by-count":6,"title":["A comparison of incidental and symptomatic unruptured brain arteriovenous malformations in children"],"prefix":"10.3171","volume":"31","author":[{"given":"Alex Y.","family":"Lu","sequence":"first","affiliation":[{"name":"Departments of Neurological Surgery,"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ethan A.","family":"Winkler","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Barrow Neurological Institute, Phoenix, Arizona;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Joseph H.","family":"Garcia","sequence":"additional","affiliation":[{"name":"Departments of Neurological Surgery,"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kunal P.","family":"Raygor","sequence":"additional","affiliation":[{"name":"Departments of Neurological Surgery,"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Heather J.","family":"Fullerton","sequence":"additional","affiliation":[{"name":"Department of Neurology, Pediatric Stroke and Cerebrovascular Disease Center, University of California, San Francisco, California; and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christine K.","family":"Fox","sequence":"additional","affiliation":[{"name":"Department of Neurology, Pediatric Stroke and Cerebrovascular Disease Center, University of California, San Francisco, California; and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Helen","family":"Kim","sequence":"additional","affiliation":[{"name":"Department of Anesthesia and Perioperative Care, Center for Cerebrovascular Research, University of California, San Francisco, California"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kurtis I.","family":"Auguste","sequence":"additional","affiliation":[{"name":"Departments of Neurological Surgery,"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Peter P.","family":"Sun","sequence":"additional","affiliation":[{"name":"Departments of Neurological Surgery,"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Steven W.","family":"Hetts","sequence":"additional","affiliation":[{"name":"Radiology and Biomedical Imaging, and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michael T.","family":"Lawton","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Barrow Neurological Institute, Phoenix, Arizona;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Adib A.","family":"Abla","sequence":"additional","affiliation":[{"name":"Departments of Neurological Surgery,"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nalin","family":"Gupta","sequence":"additional","affiliation":[{"name":"Departments of Neurological Surgery,"},{"name":"Pediatrics, University of California, San Francisco, California;"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1754","reference":[{"issue":"2","key":"b1","series-title":"Cerebrovasc Dis","first-page":"222","article-title":"Gamma Knife radiosurgery for incidental, symptomatic unruptured, and ruptured brain arteriovenous malformations","volume":"50","author":"Kim BS","year":"2021","unstructured":"Kim BS, Yeon JY, Shin HS,  Gamma Knife radiosurgery for incidental, symptomatic unruptured, and ruptured brain arteriovenous malformations. 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