Abstract
Background: The objective of this retrospective study is to determine the value of radiosurgery in the management of arteriovenous malformations (AVM) in the pediatric age group. Methods: From January 1994 through January 1999, thirty-one children with arteriovenous malformations (AVMs) were treated with radiosurgery. All patients were treated on an outpatient basis at the same institution by the same team. The Leksell Gamma Knife unit was used. Workup included angiography, MRI, and MRA. Follow-up ranged from 7 months to 67 months, with a median of 33 months. Minimum doses of radiation, depending on the size of the lesion, ranged from 20 Gy to 25 Gy. Treatment volumes for all the vascular malformations ranged from 0.6 cc to 17 cc with a mean volume of 4.7 cc. The mean number of isocenters was 4.8. Results: Total obliteration of AVM nidus was obtained in 22 of 31 (71%) patients, while 9 patients had partial obliteration. Stabilization of the benign lesions was obtained in all the patients treated. None had rebleeding after the procedure and, as of this writing, no patient required retreatment. Conclusion: Radiosurgery is an effective noninvasive and safe therapeutic modality for the management of vascular malformations independent of location, size, or grade.
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REFERENCES
Corn BW, Curran WJ Jr, Shrieve DC, Loeffler JS: Stereotactic radiosurgery and radiotherapy: New developments and new directions. Semin Oncol 29:1707–1714, 1997
Tsao MN, Wara WM, Larson DA: Radiation therapy for benign central nervous system disease. Semin Rad Oncol 9:120–133, 1999
Steiner L: Radiosurgery in cerebral arteriovenous malformations. In Cerebrovascular surgery. JM Fein, ES Flamm, (eds). New York, Springer-Verlag, 1985, pp. 1161–1251
Maesawa S, Kondiziolka D, Lunsford LD: Stereotactic radiosurgery for management of deep brain cavernous malformations. Neurosurg Clin NA 10:503–511, 1999
Elisevich K, Ratkewicz A, Lownie S: Radiosurgery of deep arteriovenous malformations of the brain. Neurosurg Quart 9:33–48, 1999
Coy SR, Houdek PV: Radiosurgery treatment planning. Semin Rad Oncol 5:213–219, 1995
Spetzler RF, Martin NA: A proposed grading system for arteriovenous malformations. J Neurosurg 65:476–483, 1986
Osborn AG: Intracranial Vascular Malformations. In Diagnostic neuroradiology. DG Osborn (ed). St. Louis, Mosby, 1994, pp. 284–329
Morgan MK, Johnston IH, Hallinan JM, et al: Complications of surgery for arteriovenous-malformations of the brain. J Neurosurg 78:176–182, 1993
Ogilvy CS: Radiation therapy for arteriovenous malformations: A review. Neurosurgery 26:725–735, 1990
Schneider BF, Eberhard DA, Steiner LE: Histopathology of arteriovenous malformations after gamma knife radiosurgery. J Neurosurg 87:352–357, 1997
Ondra SL, Troupp H, George ED, Schwab K: The natural history of symptomatic arteriovenous malformations of the brain: A 24-year follow-up assessment. J Neurosurg 73:387–391, 1990
Pollock BE, Gorman DA, Schomberg PJ, Kline RW: The Mayo Clinic Gamma Knife experience: Indications and initial results. Mayo Clin Proc 74:5–13, 1999
Heros RC, Korosue K, Diebold PM: Surgical excision of cerebral arteriovenous malformations: Late results. Neurosurgery 26:570–578, 1990
Sasaki T, Kurita H, Saito I, et al: Arteriovenous malformations in the basal ganglia and thalamus: Management and results in 101 cases. J Neurosurg 88:285–292, 1998
Friedman WA, Blatt D, Bova FJ, et al: The risk of hemorrhage after radiosurgery for arteriovenous malformations. J Neurosurg 84:912–919, 1996
Pollock BE, Flickinger JC, Lunsford LD, et al: Hemorrhage risk after stereotactic radiosurgery of cerebral arteriovenous malformations. Neurosurgery 38:652–659, 1996
Karlsson B, Linquist C, Steiner L: Effect of Gamma Knife surgery on the risk of rupture prior to AVM obliteration. Minim Invasive Neurosurg 39:21–27, 1996
Loeffler JS, Alexander E III, Siddon RL, et al: Stereotactic radiosurgery for intracranial arteriovenous malformations using a standard linear accelerator. Int J Radiat Oncol Biol Phys 17:673–677, 1989
Friedman WA, Bova FJ: Linear accelerator radiosurgery for arteriovenous malformations. J Neurosurg 77:832–841, 1992
Colombo F, Pozza F, Chierego E, et al: Linear accelerator radiosurgery of cerebral arteriovenous malformations: An update. Neurosurgery 34:14–21, 1994
Engenhart R, Wowra B, Debus J, et al: The role of high-dose, single-fraction irradiation in small and large intracranial arteriovenous malformations. Int J Radiat Onc Biol Phys 30:521–529, 1994
Yamamoto M, Jimbo M, Kobayashi M, et al: Long-term results of radiosurgery for arteriovenous malformation: neurodiagnostic imaging and histological studies of angiographically confirmed nidus obliteration. Surg Neurol 37:219–230, 1992
Karlsson B, Lindquist C, Steiner L: Prediction of obliteration after Gamma Knife surgery for cerebral arteriovenous malformations. Neurosurgery 40:425–431, 1997
Miyawaki L, Dowd C, Wara W, et al: Five year results of LINAC radiosurgery for arteriovenous malformations: Outcome for large AVMS. Int J Radiat Onc Biol Phys 44:1089–1106, 1999
Morgan MK, Sekhon L, Finfer S, Grinnell V: Delayed neurological deterioration following resection of arteriovenous malformations of the brain. J Neurosurg 90:695–701, 1999
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Amendola, B.E., Wolf, A., Coy, S.R. et al. Radiosurgery for Intracranial Arteriovenous Malformations in Children. Journal of Radiosurgery 3, 159–164 (2000). https://doi.org/10.1023/A:1009525424136
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DOI: https://doi.org/10.1023/A:1009525424136