Document Detail

Radiosurgery for arteriovenous malformations in children.
MedLine Citation:
PMID:  16776373     Owner:  NLM     Status:  MEDLINE    
OBJECT: The authors present the results of stereotactic radiosurgery performed in a consecutive series of children with arteriovenous malformations (AVMs) and analyze factors associated with successful radiosurgery for this condition. METHODS: Between 1990 and 2001, 38 patients 18 years of age or younger underwent radiosurgery for AVMs. The median patient age was 15 years; 20 patients (53%) had experienced a prior hemorrhage. Twenty-seven AVMs (71%) were Spetzler-Martin Grade III or higher; 16 patients (42%) had AVMs located in the basal ganglia, thalamus, or brainstem. The median AVM volume was 3.4 cm3. The median radiosurgery-based AVM score was 1.08 according to the following formula: AVM score = 0.1 volume (cm3) + 0.02 x age (years) + 0.3 x location (frontal/temporal = 0; parietal/occipital/corpus callosum/cerebellar = 1; basal ganglia/thalamus/brainstem = 2). The median follow-up period was 42 months. One patient (3%) had an intraventricular hemorrhage 26 months after radiosurgery but experienced no new deficit. No patient had a permanent radiation-related complication after radiosurgery. Twenty-six patients (68%) had excellent outcomes (as defined by complete obliteration of the AVM with no new deficit) after radiosurgical treatment (21 cases determined using angiography and five using magnetic resonance imaging). Twelve patients (32%) remained unchanged (incomplete obliteration but no new deficit). Univariate analysis found that patient age, AVM volume, location, or Spetzler-Martin grade did not correlate with excellent outcomes. Patients whose radiosurgery-based AVM scores were 1 or lower experienced an excellent outcome more frequently than patients with an AVM score higher than 1 (88% compared with 52%, p = 0.03). CONCLUSIONS: Radiosurgery was successful in the treatment of the majority of pediatric patients suffering from AVMs, and morbidity levels were minimal. The radiosurgery-based AVM grading scale accurately predicted these outcomes. Children whose AVMs are obliterated after radiosurgery should undergo repeated angiography after they reach adulthood to rule out the possibility of a recurrent nidus that would expose them to an ongoing risk of hemorrhage.
Aaron A Cohen-Gadol; Bruce E Pollock
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Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  Journal of neurosurgery     Volume:  104     ISSN:  0022-3085     ISO Abbreviation:  J. Neurosurg.     Publication Date:  2006 Jun 
Date Detail:
Created Date:  2006-06-16     Completed Date:  2006-07-18     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  0253357     Medline TA:  J Neurosurg     Country:  United States    
Other Details:
Languages:  eng     Pagination:  388-91     Citation Subset:  AIM; IM    
Departments of Neurologic Surgery and Radiation Oncology, Mayo Clinic College of Medicine, Rochester, Minnesota 55905, USA.
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MeSH Terms
Cerebral Angiography
Follow-Up Studies
Intracranial Arteriovenous Malformations / pathology,  radiography,  surgery*
Magnetic Resonance Imaging
Radiotherapy Planning, Computer-Assisted
Retrospective Studies
Severity of Illness Index
Treatment Outcome

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