Document Detail

Gamma Knife surgery for arteriovenous malformations in children.
MedLine Citation:
PMID:  21039165     Owner:  NLM     Status:  MEDLINE    
OBJECT: The aim of this study was to evaluate the long-term imaging and clinical outcomes of intracranial arteriovenous malformations (AVMs) in children treated with Gamma Knife surgery (GKS).
METHODS: Between 1989 and 2007, 200 patients with AVMs who were 18 years of age or younger were treated at the University of Virginia Health System. Excluding 14 patients who had not reached 2-year follow-up, 186 patients comprised this study. Hemorrhage was the most common presenting symptom leading to the diagnosis of AVMs (71.5%). The mean nidus volume was 3.2 cm(3) at the time of GKS, and a mean prescription dose of 21.9 Gy was used.
RESULTS: After initial GKS, 49.5% of patients achieved total angiographic obliteration. Forty-one patients whose AVM nidi remained patent underwent additional GKS. The obliteration rate increased to 58.6% after a second or multiple GKS. Subtotal obliteration was achieved in 9 patients (4.8%). Forty-nine patients (26.3%) still had a patent residual nidus. In 19 patients (10.2%), obliteration was confirmed on MR imaging only. Ten patients had 17 hemorrhages during the follow-up period. The hemorrhage rate was 5.4% within 2 years after GKS and 0.8% between 2 and 5 years. Six patients developed neurological deficits along with the radiation-induced changes. Two patients developed asymptomatic meningiomas 10 and 12 years after GKS. After a mean clinical follow-up of 98 months, less than 4% of patients had difficulty attending school or developing a career.
CONCLUSIONS: Gamma Knife surgery offers a reasonable chance of obliteration of an AVM in pediatric patients. The incidence of symptomatic radiation-induced changes is relatively low; however, long-term clinical and imaging follow-up is required to identify delayed cyst formation and secondary tumors.
Chun Po Yen; Stephen J Monteith; James H Nguyen; Jessica Rainey; David J Schlesinger; Jason P Sheehan
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Publication Detail:
Type:  Journal Article; Webcasts    
Journal Detail:
Title:  Journal of neurosurgery. Pediatrics     Volume:  6     ISSN:  1933-0715     ISO Abbreviation:  J Neurosurg Pediatr     Publication Date:  2010 Nov 
Date Detail:
Created Date:  2010-11-02     Completed Date:  2010-11-29     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  101463759     Medline TA:  J Neurosurg Pediatr     Country:  United States    
Other Details:
Languages:  eng     Pagination:  426-34     Citation Subset:  IM    
Department of Neurological Surgery, University of Virginia Health System, Charlottesville, Virginia 22908, USA.
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MeSH Terms
Brain Damage, Chronic / etiology
Cerebral Angiography
Cerebral Hemorrhage / etiology
Child, Preschool
Follow-Up Studies
Intracranial Arteriovenous Malformations / diagnosis,  radiography,  surgery*
Learning Disorders / etiology
Meningeal Neoplasms / etiology
Meningioma / etiology
Postoperative Complications / etiology
Radiosurgery / methods*
Comment In:
J Neurosurg Pediatr. 2010 Nov;6(5):424; discussion 424-5   [PMID:  21039164 ]

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine

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