Gamma Knife radiosurgery for arteriovenous malformations in pediatric patients

Börcek, Alp Özgün; Emmez, Hakan; Akkan, Koray; Öcal, Özgür; Kurt, Gökhan; Aykol, Şükrü; Karahacioğli, Eray; Baykaner, Kemali

doi:10.1007/s00381-014-2469-5

Cited by 31 publications

(9 citation statements)

References 18 publications

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“…This is largely due to the fact that most of the patients in our cohort were treated via radiosurgery, and the actuarial obliteration rate of radiosurgery in pediatric patients is largely variable in the reported literature (18%-88.1%, with most around 30%-50%). 2,9,40,42,49,57 Our AVM obliteration rate in pediatric patients falls within this range, albeit lower than reported in adult series.…”

Section: Discussion Hemorrhagic Risk Of Avmssupporting

confidence: 44%

“…Despite advancement of techniques in AVM manage- ment, the risk of hemorrhage persists after treatment and is reported to be 1.4% overall per patient per year in the general patient population. 48 In regard to pediatric patients with AVMs, this rate is 0.3%-4.3% for patients who underwent radiosurgery, 2,3,8,9,17,21,29,37,42,43,54,56,57 and 0%-0.3% for patients after resection. 8,16,50 To the best of our knowledge, this is the first study attempting to compare posttreatment hemorrhagic risk across different treatment modalities in a single cohort of pediatric patients with AVMs.…”

Section: Discussion Hemorrhagic Risk Of Avmsmentioning

confidence: 99%

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Long-term hemorrhagic risk in pediatric patients with arteriovenous malformations

Yang¹,

Anderson-Keightly²,

Westbroek³

et al. 2016

PED

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OBJECTIVE Compared with the general population, the specific natural history of arteriovenous malformations (AVMs) in pediatric patients is less well understood. Furthermore, few pediatric studies have compared posttreatment hemorrhagic risk and functional outcome across different treatment modalities. The objective of this study was to elucidate these points. METHODS The authors retrospectively reviewed all pediatric patients with AVMs evaluated at their institution between 1990 and 2013. The AVM natural history was represented by hemorrhagic risk during the observation period. For treated patients, the observation period was defined as the interval between diagnosis and treatment. Posttreatment hemorrhagic risk and functional outcomes were also assessed. RESULTS A total of 124 pediatric patients with AVMs were evaluated, and 90 patients (72.6%) were retained through follow-up. The average patient age was 13.3 ± 3.8 years, with a mean follow-up period of 9.95 years. The overall AVM obliteration rate was 59.7%. Radiosurgery had an obliteration rate of 49.0%. Thirteen patients were managed conservatively. Four patients under observation hemorrhaged during a total interval of 429.4 patient-years, translating to an annual risk of 0.9%. Posttreatment hemorrhagic risk by treatment modalities were categorized as follows: surgery ± embolization (0.0%), radiosurgery ± embolization (0.8%), embolization alone (2.8%), surgery + radiosurgery ± embolization (3.5%), and observation (0.8%). A significantly higher risk of posttreatment hemorrhage was observed for patients with hemorrhagic presentation (p = 0.043) in multivariate analysis. Seizure presentation, frontal lobe location, nonheadache presentation, and treatment modality were significantly associated with increased risk of poor functional outcomes. CONCLUSIONS In this study of pediatric patients with AVMs, the natural history of hemorrhage was relatively low at 0.9%. Resection remained the optimal management for hemorrhage control and functional outcome perseverance in these pediatric patients with AVMs. AVM obliteration is a valid treatment goal, especially for patients with ruptured presentation, to prevent further hemorrhages later in life.

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Section: Discussion Hemorrhagic Risk Of Avmssupporting

confidence: 44%

Section: Discussion Hemorrhagic Risk Of Avmsmentioning

confidence: 99%

Long-term hemorrhagic risk in pediatric patients with arteriovenous malformations

Yang¹,

Anderson-Keightly²,

Westbroek³

et al. 2016

PED

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“…423,439 For AVMs with similar anatomy, radiation therapy is reported to provide 63% to 85% cure rates. 442,443 Management of deep lesions, including thalamic and brainstem AVMs, is higher risk but can still provide reasonable outcomes in selected cases (54% radiographic cure). 439,441,442,444,445 Higher-grade lesions have lower rates of successful treatment (≈35%) with radiosurgery.…”

Section: Genetic Screeningmentioning

confidence: 99%

Management of Stroke in Neonates and Children: A Scientific Statement From the American Heart Association/American Stroke Association

Ferriero¹,

Fullerton²,

Bernard³

et al. 2019

Stroke

445

493

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Purpose-Much has transpired since the last scientific statement on pediatric stroke was published 10 years ago. Although stroke has long been recognized as an adult health problem causing substantial morbidity and mortality, it is also an important cause of acquired brain injury in young patients, occurring most commonly in the neonate and throughout childhood. This scientific statement represents a synthesis of data and a consensus of the leading experts in childhood cardiovascular disease and stroke. Methods-Members of the writing group were appointed by the American Heart Association Stroke Council's Scientific Statement Oversight Committee and the American Heart Association's Manuscript Oversight Committee and were chosen to reflect the expertise of the subject matter. The writers used systematic literature reviews, references to published clinical and epidemiology studies, morbidity and mortality reports, clinical and public health guidelines, authoritative statements, personal files, and expert opinion to summarize existing evidence and to indicate gaps in current knowledge. This scientific statement is based on expert consensus considerations for clinical practice. Results-Annualized pediatric stroke incidence rates, including both neonatal and later childhood stroke and both ischemic and hemorrhagic stroke, range from 3 to 25 per 100 000 children in developed countries. Newborns have the highest risk ratio: 1 in 4000 live births. Stroke is a clinical syndrome. Delays in diagnosis are common in both perinatal and childhood stroke but for different reasons. To develop new strategies for prevention and treatment, disease processes and risk factors that lead to pediatric stroke are discussed here to aid the clinician in rapid diagnosis and treatment. The many important differences that affect the pathophysiology and treatment of childhood stroke are discussed in each section. Conclusions-Here we provide updates on perinatal and childhood stroke with a focus on the subtypes, including arterial ischemic, venous thrombotic, and hemorrhagic stroke, and updates in regard to areas of childhood stroke that have not received close attention such as sickle cell disease. Each section is highlighted with considerations for clinical practice, attendant controversies, and knowledge gaps. This statement provides the practicing provider with much-needed updated information in this field. (Stroke. 2019;50:e00-e00.

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“…Reported complication rates range from 1.5% 9 to 15.5%. 9 The majority of these complications are reported as post-GK hemorrhage, that are well within the expected natural history of these lesions.…”

mentioning

confidence: 65%

“…Small numbers of retrospective case series have appeared in the literature over the last ten years reporting AVM response to Gamma Knife (GK) in the pediatric population. [6][7][8][9][10][11][12] Obliteration rates for pediatric AVMs with GK SRS range from 65% 7 to 82.7% 6 at three years follow-up. Reported complication rates range from 1.5% 9 to 15.5%.…”

mentioning

confidence: 99%

Gamma Knife Radiosurgery for Pediatric Arteriovenous Malformations: A Canadian Experience

Zeiler

Janik

McDonald

et al. 2015

Can. J. Neurol. Sci.

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Background: Gamma Knife (GK) radiosurgery for pediatric arteriovenous malformations (AVM) of the brain presents a non-invasive treatment option. We report our institutional experience with GK for pediatric AVMs. Methods: We performed a retrospective review of all pediatric patients treated with GK for cerebral AVMs at our institution from November 2003 up to and including September 2014. Patient demographics, AVM characteristics, treatment parameters and AVM responses were recorded. Results: Nineteen patients were treated, with 4 lost to follow-up. The mean age was 14.2 years (range. 7-18 years), with 10 being males (52.6%). The mean AVM diameter and volume were 2.68 cm and 3.10 cm 3 respectively. The mean Spetzler-Martin (SM) and Pollock grades of the treated AVMs were 2.4 and 0.99 respectively. The mean follow-up was 62 months. All AVMs treated demonstrated a response on follow-up imaging. Nine of 15 (60.0%) patients displayed obliteration of their AVMs. Nine of 11 patients with a minimum of 3 years follow-up (81.8%) displayed obliteration, with SM and Pollock grades correlating to the chance of obliteration in this group. Two patients developed post-GK edema requiring short course dexamethasone therapy. No other major complications occurred. No permanent complications occurred. Conclusions: GK radiosurgery for pediatric AVMs offers a safe and effective treatment option, with low permanent complication rates during early follow-up.RÉSUMÉ: Expérience canadienne de la radiochirurgie par scalpel gamma utilisée dans le traitement de malformations artérioveineuses chez l'enfant. Contexte : La radiochirurgie par scalpel gamma (SG) constitue une option de traitement non-invasive pour les malformations artérioveineuses (MAV) chez l'enfant. Nous rapportons notre expérience de l'utilisation du SG pour traiter des MAV chez des enfants dans notre institution. Méthode : Nous avons effectué une revue rétrospective de tous les dossiers de patients d'âge pédiatrique traités par SG pour une MAV dans notre institution entre novembre 2003 et septembre 2014 inclusivement. Nous avons relevé les données démographiques des patients, les caractéristiques des MAV, les paramètres de traitement et les résultats obtenus. Résultats : Dix-neuf patients ont été traités, dont 4 ont été perdus au suivi. L'âge moyen des patients était de 14,2 ans (écart de 7 à 18 ans) et 10 d'entre eux étaient des garçons (52,6%). Le diamètre moyen de la MAV et son volume étaient de 2,68 cm et 3,10 cm3 respectivement. Le grade moyen à l'échelle Spetzler-Martin (SM) et à l'échelle Pollock des MAV traitées étaient de 2,4 et 0,99 respectivement. Le suivi moyen était de 62 mois. À l'imagerie, une réponse au traitement était évidente au niveau de toutes les MAV traitées. Chez 9 patients sur 15 (60%) la MAV était oblitérée. Chez 9 patients sur 11, après un suivi minimum de 3 ans (81,8%), l'oblitération a été constatée avec des grades de SM et de Pollock compatibles avec une oblitération chez ce groupe de patients. Deux patients ont présenté de l'oedème apr...

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Gamma Knife radiosurgery for arteriovenous malformations in pediatric patients

Cited by 31 publications

References 18 publications

Long-term hemorrhagic risk in pediatric patients with arteriovenous malformations

Long-term hemorrhagic risk in pediatric patients with arteriovenous malformations

Management of Stroke in Neonates and Children: A Scientific Statement From the American Heart Association/American Stroke Association

Gamma Knife Radiosurgery for Pediatric Arteriovenous Malformations: A Canadian Experience

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