Stereotactic radiosurgery for pediatric intracranial arteriovenous malformations: the University of California at San Francisco experience

Smyth, Matthew D.; Sneed, Penny K.; Ciricillo, Samuel F.; Edwards, Michael S. B.; Wara, William M.; Larson, David A.; Lawton, Michael T.; Gutin, Philip H.; McDermott, Michael W.

doi:10.3171/jns.2002.97.1.0048

Cited by 109 publications

(41 citation statements)

References 37 publications

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“…The angiographic obliteration rates after radiosurgery have been satisfactory, ranging from 45% to 86% (Table 3). 21,27,28,31,33,37 The only exception is the report by Smyth et al 38 who reported an obliteration rate of only 27%. If MR imaging findings deomonstrating obliteration and patients in whom obliteration was attained after additional radiosurgery were included, the obliteration rates increased to a range of 58%-86%.…”

Section: Radiosurgery For Pediatric Avmsmentioning

confidence: 64%

“…Based on the reported series of pediatric AVMs treated with radiosurgery, the hemorrhage rate during the latency period ranged from 0.6% to 3.2%, 21,27,28,31,33,37,38 which is similar to the natural history of untreated AVMs. This again demonstrates that partial obliteration offered by radiosurgery provides no protection against rupture of residual AVMs (Table 3).…”

Section: Hemorrhage and Complications Following Gksmentioning

confidence: 92%

“…21,27,28,31,33,37 One has to note that most of the radiosurgical series treated small nidi with a mean nidus volume between 1.7 and 3.2 cm 3 . Smyth et al 38 explained that their meager result might be due to larger nidi and more conservative prescription doses. The only radiosurgical series with relatively large AVMs was reported by Pan et al, 31 in which an obliteration rate of 65% after 1 GKS session and 81% after additional GKS were recorded in a group of patients with a mean nidus volume of 11.7 cm 3 .…”

Section: Radiosurgery For Pediatric Avmsmentioning

confidence: 99%

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Gamma Knife surgery for arteriovenous malformations in children

Yen¹,

Monteith²,

Nguyen³

et al. 2010

PED

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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 cm3 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.

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Section: Radiosurgery For Pediatric Avmsmentioning

confidence: 64%

Section: Hemorrhage and Complications Following Gksmentioning

confidence: 92%

Section: Radiosurgery For Pediatric Avmsmentioning

confidence: 99%

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Gamma Knife surgery for arteriovenous malformations in children

Yen¹,

Monteith²,

Nguyen³

et al. 2010

PED

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“…19,25,27,34,35,37 In the present series, 2 patients (1.5%) developed permanent neurological deficits due to AREs. Six patients (4.4%) experienced temporary neurological symptoms or signs.…”

Section: Complications Of Srsmentioning

confidence: 89%

“…However, their cumulative hemorrhage risk is greater given the earlier age of detection of their AVM. Smyth et al 37 suggested that early intervention for pediatric AVMs provided the best potential for benefit.…”

Section: Discussionmentioning

confidence: 99%

Stereotactic radiosurgery for arteriovenous malformations, Part 2: management of pediatric patients

Kano

Kondziolka

Flickinger

et al. 2012

PED

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Object The authors conducted a study to define the long-term outcomes and risks of stereotactic radiosurgery (SRS) for pediatric arteriovenous malformations (AVMs). Methods Between 1987 and 2006, the authors performed Gamma Knife surgery in 996 patients with brain AVMs; 135 patients were younger than 18 years of age. The median maximum diameter and target volumes were 2.0 cm (range 0.6–5.2 cm) and 2.5 cm3 (range 0.1–17.5 cm3), respectively. The median margin dose was 20 Gy (range 15–25 Gy). Results The actuarial rates of total obliteration documented by angiography or MR imaging at 71.3 months (range 6–264 months) were 45%, 64%, 67%, and 72% at 3, 4, 5, and 10 years, respectively. The median time to complete angiographically documented obliteration was 48.9 months. Of 81 patients with 4 or more years of follow-up, 57 patients (70%) had total obliteration documented by angiography. Factors associated with a higher rate of documented AVM obliteration were smaller AVM target volume, smaller maximum diameter, and larger margin dose. In 8 patients (6%) a hemorrhage occurred during the latency interval, and 1 patient died. The rates of AVM hemorrhage after SRS were 0%, 1.6%, 2.4%, 5.5%, and 10.0% at 1, 2, 3, 5, and 10 years, respectively. The overall annual hemorrhage rate was 1.8%. Larger volume AVMs were associated with a significantly higher risk of hemorrhage after SRS. Permanent neurological deficits due to adverse radiation effects developed in 2 patients (1.5%) after SRS, and in 1 patient (0.7%) delayed cyst formation occurred. Conclusions Stereotactic radiosurgery is a gradually effective and relatively safe management option for pediatric patients in whom surgery is considered to pose excessive risks. Although hemorrhage after AVM obliteration did not occur in the present series, patients remain at risk during the latency interval until obliteration is complete. The best candidates for SRS are pediatric patients with smaller volume AVMs located in critical brain regions.

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