Neurocognitive outcomes in pediatric brain arteriovenous malformations: a systematic review

Abstract

Introduction Pediatric brain arteriovenous malformations (AVMs) are an important cause of hemorrhagic stroke and long-term morbidity. Neurocognitive outcomes remain incompletely characterized. Objective To synthesize reported neurocognitive, educational, and occupational outcomes in individuals diagnosed with brain AVMs before 18 years of age. Methods PubMed, Scopus, Web of Science, the Cochrane Library, and ScienceDirect were searched from January 1995 through June 5, 2026, according to a prospectively registered International Prospective Register of Systematic Reviews protocol (PROSPERO; CRD420261352472). Studies reporting at least one neurocognitive, educational, or occupational outcome in individuals diagnosed with a brain AVM before 18 years of age were eligible irrespective of management strategy. Because of clinical and methodological heterogeneity, findings were synthesized narratively. Results Twelve studies involving 287 individuals diagnosed in childhood were included. Participant ages at assessment, follow-up periods, study designs, and neurocognitive instruments varied substantially. Reported intelligence quotient (IQ) scores ranged from 81 to 124, although scores from different instruments and developmental stages were not directly comparable. Across studies, reported outcomes included attention or cognitive difficulties, need for educational support, reduced academic performance, and limitations in school or work participation, while other participants maintained average or above-average functioning. Occupational outcomes were reported in only a small number of long-term follow-up studies. No comparative neurocognitive benefit of a specific management strategy could be established. Conclusion Reported neurocognitive and educational outcomes after pediatric brain AVM diagnosis were heterogeneous, and evidence concerning occupational outcomes was sparse. Prospective studies using age-appropriate, standardized longitudinal neurocognitive assessments are needed.