{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,1]],"date-time":"2026-09-01T11:14:12Z","timestamp":1788261252829,"version":"build-2803163510"},"reference-count":17,"publisher":"MDPI AG","issue":"9","license":[{"start":{"date-parts":[[2026,9,1]],"date-time":"2026-09-01T00:00:00Z","timestamp":1788220800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Medicina"],"abstract":"<jats:p>Background and Objectives: brain arteriovenous malformations (AVMs) are a leading cause of spontaneous intracranial hemorrhage in children and carry a disproportionately high lifetime hemorrhagic risk. Materials and Methods: We retrospectively analyzed clinical, morphological, and surgical factors associated with functional outcome in 30 consecutive pediatric patients (\u226418 years) who underwent microsurgical AVM resection at a single tertiary neurosurgical center between January 2015 and December 2025. Results: Functional status was assessed with the modified Rankin Scale (mRS) at hospital discharge and at 6\u20139 months of follow-up; the Wilcoxon signed-rank test, Mann\u2013Whitney U test, Fisher\u2019s exact test, Spearman correlation, and univariable logistic regression were used for analysis. Complete resection on early postoperative CT angiography was documented in all 30 patients (100%). The proportion with a favorable outcome (mRS 0\u20132) improved significantly from 50.0% at discharge to 76.7% at follow-up (p &lt; 0.0001); 80.8% of survivors improved by at least one mRS point, and none deteriorated. In univariable analysis, the variable most strongly associated with poor outcome was intraventricular hemorrhage (IVH; odds ratio [OR] 28.5, 95% CI 2.65\u2013306.6; p = 0.002); the wide confidence interval reflects the small number of events and precludes a precise estimate of effect size. Lower admission Glasgow Coma Scale (GCS) score (p = 0.0006), higher Supplemented Spetzler\u2013Martin (S\u2013M) grade (p = 0.019), and postoperative complications (p = 0.016) were likewise associated with poor outcome. Because these associations are univariable and unadjusted for confounding, they should be regarded as exploratory and hypothesis-generating rather than as independent predictors. All four deaths occurred in malformations in eloquent locations (p = 0.037). Microsurgical resection achieved complete resection on early postoperative CT angiography in all patients; however, functional recovery appeared to be associated primarily with the severity of the initial hemorrhagic insult\u2014particularly IVH\u2014and with lesion complexity rather than with the achievement of angiographic resection alone. Conclusions: Given the small, surgically selected cohort and the limited follow-up, these findings require confirmation in larger multicenter studies.<\/jats:p>","DOI":"10.3390\/medicina62091679","type":"journal-article","created":{"date-parts":[[2026,9,1]],"date-time":"2026-09-01T09:48:36Z","timestamp":1788256116000},"page":"1679","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Beyond Resection: Determinants of Outcome After Pediatric Brain Arteriovenous Malformation Surgery"],"prefix":"10.3390","volume":"62","author":[{"given":"Goran","family":"Tasi\u0107","sequence":"first","affiliation":[{"name":"Department for Cerebrovascular Diseases and Vascular Anomalies, Clinic of Neurosurgery, University Clinical Centre of Serbia, 11000 Belgrade, Serbia"},{"name":"Faculty of Medicine, University of Belgrade, 11000 Belgrade, Serbia"}],"role":[{"vocabulary":"crossref","role":"author"},{"role":"conceptualization","vocabulary":"credit"},{"role":"writing-review-editing","vocabulary":"credit"},{"role":"supervision","vocabulary":"credit"}]},{"ORCID":"https:\/\/orcid.org\/0009-0002-1423-1574","authenticated-orcid":false,"given":"Aleksandar","family":"Jani\u0107ijevi\u0107","sequence":"additional","affiliation":[{"name":"Department for Cerebrovascular Diseases and Vascular Anomalies, Clinic of Neurosurgery, University Clinical Centre of Serbia, 11000 Belgrade, Serbia"},{"name":"Faculty of Medicine, University of Belgrade, 11000 Belgrade, Serbia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0002-3659-9409","authenticated-orcid":false,"given":"Jelena","family":"Kosti\u0107","sequence":"additional","affiliation":[{"name":"Department for Cerebrovascular Diseases and Vascular Anomalies, Clinic of Neurosurgery, University Clinical Centre of Serbia, 11000 Belgrade, Serbia"}],"role":[{"vocabulary":"crossref","role":"author"},{"role":"conceptualization","vocabulary":"credit"},{"role":"investigation","vocabulary":"credit"},{"role":"data-curation","vocabulary":"credit"},{"role":"visualization","vocabulary":"credit"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3064-7297","authenticated-orcid":false,"given":"Aleksandar","family":"Milosavljevi\u0107","sequence":"additional","affiliation":[{"name":"Clinic of Neurosurgery, University Clinical Center of Kragujevac, 34000 Kragujevac, Serbia"},{"name":"Faculty of Medical Science, University of Kragujevac, 34000 Kragujevac, Serbia"}],"role":[{"vocabulary":"crossref","role":"author"},{"role":"methodology","vocabulary":"credit"},{"role":"investigation","vocabulary":"credit"},{"role":"writing-review-editing","vocabulary":"credit"}]},{"given":"Nikola","family":"Jovi\u0107evi\u0107","sequence":"additional","affiliation":[{"name":"Department for Cerebrovascular Diseases and Vascular Anomalies, Clinic of Neurosurgery, University Clinical Centre of Serbia, 11000 Belgrade, Serbia"}],"role":[{"vocabulary":"crossref","role":"author"},{"role":"visualization","vocabulary":"credit"},{"role":"formal-analysis","vocabulary":"credit"}]},{"given":"Nikola","family":"Repac","sequence":"additional","affiliation":[{"name":"Department for Cerebrovascular Diseases and Vascular Anomalies, Clinic of Neurosurgery, University Clinical Centre of Serbia, 11000 Belgrade, Serbia"},{"name":"Faculty of Medicine, University of Belgrade, 11000 Belgrade, Serbia"}],"role":[{"vocabulary":"crossref","role":"author"},{"role":"methodology","vocabulary":"credit"},{"role":"investigation","vocabulary":"credit"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8665-8230","authenticated-orcid":false,"given":"Igor","family":"Nikoli\u0107","sequence":"additional","affiliation":[{"name":"Department for Cerebrovascular Diseases and Vascular Anomalies, Clinic of Neurosurgery, University Clinical Centre of Serbia, 11000 Belgrade, Serbia"},{"name":"Faculty of Medicine, University of Belgrade, 11000 Belgrade, Serbia"}],"role":[{"vocabulary":"crossref","role":"author"},{"role":"resources","vocabulary":"credit"}]},{"given":"Ana","family":"Tasi\u0107","sequence":"additional","affiliation":[{"name":"University Children\u2019s Hospital, University Clinical Center of Serbia, 11000 Belgrade, Serbia"}],"role":[{"vocabulary":"crossref","role":"author"},{"role":"resources","vocabulary":"credit"}]},{"ORCID":"https:\/\/orcid.org\/0009-0001-8361-9284","authenticated-orcid":false,"given":"Ma\u0161a","family":"Radovanovi\u0107","sequence":"additional","affiliation":[{"name":"University Children\u2019s Hospital, University Clinical Center of Serbia, 11000 Belgrade, Serbia"}],"role":[{"vocabulary":"crossref","role":"author"},{"role":"investigation","vocabulary":"credit"}]},{"given":"Vladimir","family":"Jovanovi\u0107","sequence":"additional","affiliation":[{"name":"Department for Cerebrovascular Diseases and Vascular Anomalies, 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Neurol."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"463","DOI":"10.3171\/2023.1.PEDS22541","article-title":"A comparison of incidental and symptomatic unruptured brain arteriovenous malformations in children","volume":"31","author":"Lu","year":"2023","journal-title":"J. Neurosurg. Pediatr."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"2099","DOI":"10.1161\/01.STR.0000181746.77149.2b","article-title":"Long-term hemorrhage risk in children versus adults with brain arteriovenous malformations","volume":"36","author":"Fullerton","year":"2005","journal-title":"Stroke"},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"2358","DOI":"10.3174\/ajnr.A6824","article-title":"Risk factors for early brain AVM rupture: Cohort study of pediatric and adult patients","volume":"41","author":"Garzelli","year":"2020","journal-title":"AJNR Am. J. Neuroradiol."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"573","DOI":"10.1007\/s00381-017-3383-4","article-title":"Multimodality management and outcomes of brain arterio-venous malformations (AVMs) in children: Personal experience and review of the literature, with specific emphasis on age at first AVM bleed","volume":"33","author":"Shtaya","year":"2017","journal-title":"Childs Nerv. Syst."},{"key":"ref_6","doi-asserted-by":"crossref","unstructured":"Hsiao, M.C., Tsuei, Y.S., Pan, H.C., Sun, M.H., Chen, W.H., Chen, H.C., Shen, C.C., Li, C.R., and Chou, Y.C. (2025). Long-term outcomes of pediatric cerebral arteriovenous malformations: A ten-year single-center retrospective study. Medicina, 61.","DOI":"10.3390\/medicina61071177"},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"915","DOI":"10.1007\/s10143-019-01210-4","article-title":"Long-term outcomes and prognostic predictors of 111 pediatric hemorrhagic cerebral arteriovenous malformations after microsurgical resection: A single-center experience","volume":"44","author":"Deng","year":"2021","journal-title":"Neurosurg. Rev."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"106283","DOI":"10.1016\/j.jstrokecerebrovasdis.2021.106283","article-title":"Paediatric cerebral arteriovenous malformation: Outcomes from a Singapore Children\u2019s Hospital","volume":"31","author":"Lim","year":"2022","journal-title":"J. Stroke Cerebrovasc. Dis."},{"key":"ref_9","first-page":"82","article-title":"Superior outcomes in children compared with adults after microsurgical resection of brain arteriovenous malformations","volume":"105","author":"Chennupati","year":"2006","journal-title":"J. Neurosurg."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"409","DOI":"10.1007\/s10143-019-01101-8","article-title":"What is the best therapeutic approach to a pediatric patient with a deep-seated brain AVM?","volume":"42","author":"Meling","year":"2019","journal-title":"Neurosurg. Rev."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"1565","DOI":"10.1007\/s00701-023-05612-8","article-title":"Recurrence of brain arteriovenous malformations in pediatric patients: A long-term follow-up study","volume":"165","author":"Oulasvirta","year":"2023","journal-title":"Acta Neurochir."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"497","DOI":"10.3171\/2012.1.PEDS11453","article-title":"Follow-up imaging to detect recurrence of surgically treated pediatric arteriovenous malformations","volume":"9","author":"Lang","year":"2012","journal-title":"J. Neurosurg. Pediatr."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"40","DOI":"10.1017\/S0317167100042517","article-title":"Arteriovenous malformations of the brain in children: A forty year experience","volume":"19","author":"Kondziolka","year":"1992","journal-title":"Can. J. Neurol. Sci."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"702","DOI":"10.1227\/01.NEU.0000367555.16733.E1","article-title":"A supplementary grading scale for selecting patients with brain arteriovenous malformations for surgery","volume":"66","author":"Lawton","year":"2010","journal-title":"Neurosurgery"},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"e121","DOI":"10.1016\/j.wneu.2019.08.145","article-title":"Primary intraventricular hemorrhage in pediatric patients: Causes, characteristics, and outcomes","volume":"133","author":"Guo","year":"2020","journal-title":"World Neurosurg."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"292","DOI":"10.1016\/j.wneu.2016.04.080","article-title":"The AVICH score: A novel grading system to predict clinical outcome in arteriovenous malformation-related intracerebral hemorrhage","volume":"92","author":"Neidert","year":"2016","journal-title":"World Neurosurg."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"1051","DOI":"10.21037\/tp-24-68","article-title":"One-stop hybrid operation versus microsurgery for treating brain arteriovenous malformation in children\u2014A retrospective case series","volume":"13","author":"Chen","year":"2024","journal-title":"Transl. 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