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Objective: Arteriovenous malformations (AVMs) are the most common cause of spontaneous intracranial hemorrhage (ICH) in children, often leading to devastating complications. The current literature from the adult AVM population suggests that both younger age and associated aneurysms carry an increased risk of hemorrhagic presentation. However, detailed analysis of pediatric AVM-associated aneurysms and their link to ICH is relatively unknown, with the literature largely consisting of case reports. This study aimed to determine whether AVM-associated aneurysms predispose pediatric patients to ICH., Methods: A retrospective cohort study of 238 pediatric patients with AVMs who presented to the Children's Hospital of Pittsburgh from 1988 to 2023 was performed. Hospital records, patient charts, and radiographic imaging studies were reviewed for patient demographic characteristics, presentation status, and AVM architecture., Results: Of the 238 total patients, 44 (18.5%) children with AVM had associated aneurysms. There were 19 (38.8%) feeding artery aneurysms, 8 (16.3%) intranidal aneurysms, 21 (42.9%) postnidal aneurysms, and 1 (2.0%) unrelated aneurysm of 49 aneurysms. Five patients had venous varices. One hundred forty (58.8%) children presented with hemorrhage. Twenty-one of 44 (47.7%) patients with an AVM-associated aneurysm presented with hemorrhage, whereas 119 of 194 (61.3%) with a solitary AVM presented with hemorrhage (p = 0.10). On multivariate analysis, postnidal aneurysm (OR 0.36, p = 0.037) and an increased number of draining veins (OR 0.66, p = 0.049) were significantly associated with a decreased likelihood of hemorrhagic presentation. Deep venous drainage was associated with an increase in hemorrhagic presentation (OR 2.25, p = 0.0045) on multivariate analysis., Conclusions: Approximately one-fifth of children with AVMs in this study had accompanying aneurysms, and in this patient population, those with postnidal aneurysms and increased number of draining veins had a decreased incidence of hemorrhage on presentation. Feeding artery and intranidal aneurysms were not associated with an elevated risk of hemorrhagic presentation.

Dr Dorothy Klenke Nash (1898-1976) became the first female neurosurgeon in the United States in 1928 and maintained her status as the country's only female neurosurgeon until 1960. She graduated with her medical degree from the Columbia College of Physicians and Surgeons in 1927 and then trained at the Neurologic Institute of New York under Dr Byron Stookey. During her training, she contributed to the advancement of neurosurgical practice through academic research. In 1931, she married Charles B. Nash, and together they had 2 children, George (1932) and Dorothy Patricia (1937). Dr Nash became a senior surgeon at St. Margaret's Hospital in Pittsburgh in 1942. Shortly thereafter, she joined the inaugural University of Pittsburgh Department of Neurosurgery led by Dr Stuart N. Rowe and became an instructor of neurosurgery at the University of Pittsburgh School of Medicine. In acknowledgment of her advocacy for public access to services for mental health and cerebral palsy, Dr Nash was recognized as a Distinguished Daughter of Pennsylvania (1953) and honored by Mercy Hospital (1957), Bryn Mawr College (1960), and Columbia University (1968). She retired from neurosurgical practice in 1965, at which time she devoted herself to her grandchildren and her Catholic faith. She died on March 5, 1976 at the age of 77. With unwavering tenacity, Dr Nash paved the way for all women in neurosurgery., (© Congress of Neurological Surgeons 2021.)