Document Detail


Radiosurgery of brain arteriovenous malformations in children.
MedLine Citation:
PMID:  18283398     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
OBJECTIVE: The authors describe their experience in treating 22 children with a single brain arteriovenous malformation (bAVM) using a dedicated LINAC stereotactic radiosurgery unit. METHODS: The findings of 22 consecutive patients < or = 18 years of age who underwent radiosurgery for a single bAVM and with at least 24 months of follow-up, or earlier proven obliteration,were reviewed. The median age at radiosurgery was 13.8 years,with a hemorrhagic presentation in 86%. Median bAVM-volume was 1.8 ml, with a median prescribed marginal dose of 19.0 Gy. RESULTS: The crude complete obliteration-rate was 68% (n = 15) after a median follow-up of 24 months. The actuarial obliteration- rate was 45 % after two years and 64 % after three years. Patients with a radiosurgery-based AVM score < or = 1 more frequently had an excellent outcome than patients with a bAVM score > 1 (71% vs. 20%, P = 0.12), as well as an increased obliteration rate (P = 0.03) One patient died from a bAVM-related hemorrhage 27 months after radiosurgery, representing a postradiosurgery hemorrhage rate of 1.3%/year for the complete followup interval. Overall outcome was good to excellent in 68% (n = 15). Radiation-induced changes on MR imaging were seen in 36% (n = 8) after a median interval of 12.5 months, resulting in deterioration of pre-existing neurological symptoms in one patient. CONCLUSIONS: Radiosurgery is a relatively effective, minimally invasive treatment for small bAVMs in children. The rebleeding rate is low, provided that known predilection places for bleeding had been endovascularly eliminated.Our overall results compare unfavourably to recent pediatric microsurgical series, although comparison between series remains imprecise. Nevertheless, when treatment is indicated in a child with a bAVM that is amenable to both microsurgery or radiosurgery, microsurgery should carefully be advocated over radiosurgery, because of its immediate risk reduction.
Authors:
D R Buis; C M F Dirven; F J Lagerwaard; E S Mandl; G J Lycklama A Nijeholt; D S Eshghi; R van den Berg; J C Baayen; O W M Meijer; B J Slotman; W P Vandertop
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Publication Detail:
Type:  Journal Article     Date:  2008-02-19
Journal Detail:
Title:  Journal of neurology     Volume:  255     ISSN:  0340-5354     ISO Abbreviation:  J. Neurol.     Publication Date:  2008 Apr 
Date Detail:
Created Date:  2008-05-08     Completed Date:  2008-07-01     Revised Date:  2010-03-23    
Medline Journal Info:
Nlm Unique ID:  0423161     Medline TA:  J Neurol     Country:  Germany    
Other Details:
Languages:  eng     Pagination:  551-60     Citation Subset:  IM    
Affiliation:
Dept. of Neurosurgery, Neurosurgical Center Amsterdam, VU University Medical Center, 2F-005, PO Box 7057, 1007 MB Amsterdam, The Netherlands. dr.buis@vumc.nl
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MeSH Terms
Descriptor/Qualifier:
Adolescent
Age Factors
Brain / blood supply,  physiopathology,  surgery
Cerebral Angiography
Cerebral Arteries / abnormalities*,  radiation effects*,  radiography
Cerebral Hemorrhage / etiology,  physiopathology,  surgery
Child
Cohort Studies
Female
Follow-Up Studies
Humans
Intracranial Arteriovenous Malformations / pathology,  physiopathology,  surgery*
Male
Postoperative Hemorrhage / mortality
Radiosurgery / adverse effects,  methods*,  statistics & numerical data*
Retrospective Studies
Treatment Outcome

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


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