Skip to main content

Advertisement

SpringerLink
Log in

Radiosurgery of brain arteriovenous malformations in children

  • ORIGINAL COMMUNICATION
  • Published:
Journal of Neurology Aims and scope Submit manuscript

Abstract

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 ≤ 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 ≤ 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.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Al-Shahi R, Warlow CP (2006) Interventions for treating brain arteriovenous malformations in adults. Cochrane Database Syst RevCD003436

  2. Altschuler EM, Lunsford LD, Coffey RJ, Bissonette DJ, Flickinger JC (1989) Gamma knife radiosurgery for intracranial arteriovenous malformations in childhood and adolescence. Pediatr Neurosci 15:53–61

    Article  PubMed  CAS  Google Scholar 

  3. Amendola BE, Wolf A, Coy SR, DePrima S, Amendola MA (2000) Radiosurgery for intracranial arteriovenous malformations in children. J Radiosurg 3:159–164

    Article  Google Scholar 

  4. Bristol RE, Albuquerque FC, Spetzler RF, Rekate HL, McDougall CG, Zabramski JM (2006) Surgical management of arteriovenous malformations in children. J Neurosurg 105:88–93

    Article  PubMed  Google Scholar 

  5. Cohen-Gadol AA, Pollock BE (2006) Radiosurgery for arteriovenous malformations in children. J Neurosurg 104:388–391

    PubMed  Google Scholar 

  6. Deorah S, Lynch CF, Sibenaller ZA, Ryken TC (2006) Trends in brain cancer incidence and survival in the United States: Surveillance, Epidemiology, and End Results Program, 1973 to 2001. Neurosurg Focus 20:E1

    Article  PubMed  Google Scholar 

  7. Friedman WA, Bova FJ, Bollampally S, Bradshaw P (2003) Analysis of factors predictive of success or complications in arteriovenous malformation radiosurgery. Neurosurgery 52:296–307

    Article  PubMed  Google Scholar 

  8. Fullerton HJ, Achrol AS, Johnston SC, McCulloch CE, Higashida RT, Lawton MT, Sidney S, Young WL (2005) Longterm hemorrhage risk in children versus adults with brain arteriovenous malformations. Stroke 36:2099–2104

    Article  PubMed  Google Scholar 

  9. Fuss M, Salter BJ, Caron JL, Vollmer DG, Herman TS (2005) Intensitymodulated radiosurgery for childhood arteriovenous malformations. Acta Neurochir (Wien) 147:1141–1150

    Article  CAS  Google Scholar 

  10. Ganz JC, Reda WA, Abdelkarim K, Hafez A (2005) A simple method for predicting imaging-based complications following gamma knife surgery for cerebral arteriovenous malformations. J Neurosurg 102(Suppl):4–7

    PubMed  Google Scholar 

  11. Gauvrit JY, Oppenheim C, Nataf F, Naggara O, Trystram D, Munier T, Fredy D, Pruvo JP, Roux FX, Leclerc X, Meder JF (2006) Three-dimensional dynamic magnetic resonance angiography for the evaluation of radiosurgically treated cerebral arteriovenous malformations. Eur Radiol 16:583–591

    Article  PubMed  Google Scholar 

  12. Gerszten PC, Adelson PD, Kondziolka D, Flickinger JC, Lunsford LD (1996) Seizure outcome in children treated for arteriovenous malformations using gamma knife radiosurgery. Pediatr Neurosurg 24:139–144

    Article  PubMed  CAS  Google Scholar 

  13. Heffez DS, Osterdock RJ, Alderete L, Grutsch J (1998) The effect of incomplete patient follow-up on the reported results of AVM radiosurgery. Surg Neurol 49:373–381

    Article  PubMed  CAS  Google Scholar 

  14. Hoh BL, Ogilvy CS, Butler WE, Loeffler JS, Putman CM, Chapman PH (2000) Multimodality treatment of nongalenic arteriovenous malformations in pediatric patients. Neurosurgery 47:346–357

    Article  PubMed  CAS  Google Scholar 

  15. Izawa M, Hayashi M, Chernov M, Nakaya K, Ochiai T, Murata N, Takasu Y, Kubo O, Hori T, Takakura K (2005) Long-term complications after gamma knife surgery for arteriovenous malformations. J Neurosurg 102(Suppl):34–37

    PubMed  Google Scholar 

  16. Kim LJ, Albuquerque FC, Spetzler RF, McDougall CG (2006) Postembolization neurological deficits in cerebral arteriovenous malformations: stratification by arteriovenous malformation grade. Neurosurgery 59:53–59

    Article  PubMed  Google Scholar 

  17. Kondziolka D, Humphreys RP, Hoffman HJ, Hendrick EB, Drake JM (1992) Arteriovenous malformations of the brain in children: a forty year experience. Can J Neurol Sci 19:40–45

    PubMed  CAS  Google Scholar 

  18. Levy EI, Niranjan A, Thompson TP, Scarrow AM, Kondziolka D, Flickinger JC, Lunsford LD (2000) Radiosurgery for childhood intracranial arteriovenous malformations. Neurosurgery 47:834–841

    Article  PubMed  CAS  Google Scholar 

  19. Lindqvist M, Karlsson B, Guo WY, Kihlstrom L, Lippitz B, Yamamoto M (2000) Angiographic long-term followup data for arteriovenous malformations previously proven to be obliterated after gamma knife radiosurgery. Neurosurgery 46:803–808

    Article  PubMed  CAS  Google Scholar 

  20. Loeffler JS, Rossitch E Jr, Siddon R, Moore MR, Rockoff MA, Alexander E III (1990) Role of stereotactic radiosurgery with a linear accelerator in treatment of intracranial arteriovenous malformations and tumors in children. Pediatrics 85:774–782

    PubMed  CAS  Google Scholar 

  21. Maity A, Shu HK, Tan JE, Ruffer J, Sutton LN, Tochner Z, Lustig R (2004) Treatment of pediatric intracranial arteriovenous malformations with linear-accelerator-based stereotactic radiosurgery: the University of Pennsylvania experience. Pediatr Neurosurg 40:207–214

    Article  PubMed  Google Scholar 

  22. Maruyama K, Kawahara N, Shin M, Tago M, Kishimoto J, Kurita H, Kawamoto S, Morita A, Kirino T (2005) The risk of hemorrhage after radiosurgery for cerebral arteriovenous malformations. N Engl J Med 352:146–153

    Article  PubMed  CAS  Google Scholar 

  23. McIver JI, Pollock BE (2004) Radiation- induced tumor after stereotactic radiosurgery and whole brain radiotherapy: case report and literature review. J Neurooncol 66:301–305

    Article  PubMed  Google Scholar 

  24. Meisel HJ, Mansmann U, Alvarez H, Rodesch G, Brock M, Lasjaunias P (2002) Effect of partial targeted Nbutyl- cyano-acrylate embolization in brain AVM. Acta Neurochir (Wien) 144:879–887

    Article  CAS  Google Scholar 

  25. Nataf F, Schlienger M, Lefkopoulos D, Merienne L, Ghossoub M, Foulquier JN, Deniaud-Alexandre E, Mammar H, Meder JF, Turak B, Huart J, Touboul E, Roux FX (2003) Radiosurgery of cerebral arteriovenous malformations in children: a series of 57 cases. Int J Radiat Oncol Biol Phys 57:184–195

    PubMed  Google Scholar 

  26. Nicolato A, Foroni R, Seghedoni A, Martines V, Lupidi F, Zampieri P, Sandri MF, Ricci U, Mazza C, Beltramello A, Gerosa M, Bricolo A (2005) Leksell gamma knife radiosurgery for cerebral arteriovenous malformations in pediatric patients. Childs Nerv Syst 21:301–307

    Article  PubMed  Google Scholar 

  27. Nicolato A, Gerosa M, Ferraresi P, Piovan E, Pasoli A, Perini S, Mazza C (1997) Stereotactic radiosurgery for the treatment of arteriovenous malformations in childhood. J Neurosurg Sci 41:359–371

    PubMed  CAS  Google Scholar 

  28. Nicolato A, Lupidi F, Sandri MF, Foroni R, Zampieri P, Mazza C, Maluta S, Beltramello A, Gerosa M (2006) Gamma Knife radiosurgery for cerebral arteriovenous malformations in children/ adolescents and adults. Part I: Differences in epidemiologic, morphologic, and clinical characteristics, permanent complications, and bleeding in the latency period. Int J Radiat Oncol Biol Phys 64:904–913

    PubMed  Google Scholar 

  29. Nicolato A, Lupidi F, Sandri MF, Foroni R, Zampieri P, Mazza C, Pasqualin A, Beltramello A, Gerosa M (2006) Gamma Knife radiosurgery for cerebral arteriovenous malformations in children/adolescents and adults. Part II: Differences in obliteration rates, treatment-obliteration intervals, and prognostic factors. Int J Radiat Oncol Biol Phys 64:914–921

    PubMed  Google Scholar 

  30. Petereit D, Mehta M, Turski P, Levin A, Strother C, Mistretta C, Mackie R, Gehring M, Kubsad S, Kinsella T (1993) Treatment of arteriovenous malformations with stereotactic radiosurgery employing both magnetic resonance angiography and standard angiography as a database. Int J Radiat Oncol Biol Phys 25:309–313

    PubMed  CAS  Google Scholar 

  31. Pollock BE, Flickinger JC (2002) A proposed radiosurgery-based grading system for arteriovenous malformations. J Neurosurg 96:79–85

    PubMed  Google Scholar 

  32. Reyns N, Blond S, Gauvrit JY, Touzet G, Coche B, Pruvo JP, Dhellemmes P (2007) Role of radiosurgery in the management of cerebral arteriovenous malformations in the pediatric age group: data from a 100-patient series. Neurosurgery 60:268–276

    Article  PubMed  Google Scholar 

  33. Riva D, Pantaleoni C, Devoti M, Lindquist C, Steiner L, Giorgi C (1997) Radiosurgery for cerebral AVMs in children and adolescents: the neurobehavioral outcome. J Neurosurg 86:207–210

    PubMed  CAS  Google Scholar 

  34. Rodriguez-Arias C, Martinez R, Rey G, Bravo G (2000) Recurrence in a different location of a cerebral arteriovenous malformation in a child after radiosurgery. Childs Nerv Syst 16:363–365

    Article  PubMed  CAS  Google Scholar 

  35. Sedzimir CB, Robinson J (1973) Intracranial hemorrhage in children and adolescents. J Neurosurg 38:269–281

    PubMed  CAS  Google Scholar 

  36. Shin M, Kawahara N, Maruyama K, Tago M, Ueki K, Kirino T (2005) Risk of hemorrhage from an arteriovenous malformation confirmed to have been obliterated on angiography after stereotactic radiosurgery. J Neurosurg 102:842–846

    PubMed  Google Scholar 

  37. Shin M, Kawamoto S, Kurita H, Tago M, Sasaki T, Morita A, Ueki K, Kirino T (2002) Retrospective analysis of a 10- year experience of stereotactic radio surgery for arteriovenous malformations in children and adolescents. J Neurosurg 97:779–784

    Article  PubMed  Google Scholar 

  38. Smyth MD, Sneed PK, Ciricillo SF, Edwards MS, Wara WM, Larson DA, Lawton MT, Gutin PH, McDermott MW (2002) Stereotactic radiosurgery for pediatric intracranial arteriovenous malformations: the University of California at San Francisco experience. J Neurosurg 97:48–55

    PubMed  Google Scholar 

  39. Spetzler RF, Martin NA (1986) A proposed grading system for arteriovenous malformations. J Neurosurg 65:476–483

    PubMed  CAS  Google Scholar 

  40. Tanaka T, Kobayashi T, Kida Y, Oyama H, Niwa M (1996) Comparison between adult and pediatric arteriovenous malformations treated by Gamma Knife radiosurgery. Stereotact Funct Neurosurg 66(Suppl 1):288–295

    Article  PubMed  Google Scholar 

  41. Voges J, Treuer H, Lehrke R, Kocher M, Staar S, Muller RP, Sturm V (1997) Risk analysis of LINAC radiosurgery in patients with arteriovenous malformation (AVM). Acta Neurochir Suppl 68:118–123

    PubMed  CAS  Google Scholar 

  42. Yamamoto M, Jimbo M, Ide M, Tanaka N, Lindquist C, Steiner L (1992) Longterm follow-up of radiosurgically treated arteriovenous malformations in children: report of nine cases. Surg Neurol 38:95–100

    Article  PubMed  CAS  Google Scholar 

  43. Zabel-du Bois A, Milker-Zabel S, Huber P, Schlegel W, Debus J (2006) Stereotactic linac-based radiosurgery in the treatment of cerebral arteriovenous malformations located deep, involving corpus callosum, motor cortex, or brainstem. Int J Radiat Oncol Biol Phys 64:1044–1048

    PubMed  Google Scholar 

  44. Zabel-du Bois A, Milker-Zabel S, Huber P, Schlegel W, Debus J (2006) Pediatric cerebral arteriovenous malformations: the role of stereotactic linac-based radiosurgery. Int J Radiat Oncol Biol Phys 65:1206–1211

    PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Dept. of Neurosurgery, Neurosurgical Center Amsterdam, VU University Medical Center, 2F-005, 7057, 1007, MB Amsterdam, The Netherlands

    D. R. Buis M.D., E. S. Mandl M.D., J. C. Baayen M.D. & W. P. Vandertop M.D.,Ph.D.

  2. Dept. of Neurosurgery, Erasmus Medical Center, Rotterdam, The Netherlands

    C. M. F. Dirven M.D., Ph.D.

  3. Dept. of Radiation Oncology, VU University Medical Center, Amsterdam, The Netherlands

    F. J. Lagerwaard M.D., Ph.D., O. W. M. Meijer M.D. & B. J. Slotman M.D., Ph.D.

  4. Dept. of Radiology, Medisch Centrum Haaglanden, The Hague, The Netherlands

    G. J. Lycklama á Nijeholt M.D., Ph.

  5. Dept. of Neuroradiology, VU University Medical Center, Amsterdam, The Netherlands

    D. S. Eshghi M.D. & R. van den Berg M.D.,Ph.D.

Authors
  1. D. R. Buis M.D.
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. C. M. F. Dirven M.D., Ph.D.
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. F. J. Lagerwaard M.D., Ph.D.
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. E. S. Mandl M.D.
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. G. J. Lycklama á Nijeholt M.D., Ph.
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. D. S. Eshghi M.D.
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. R. van den Berg M.D.,Ph.D.
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. J. C. Baayen M.D.
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. O. W. M. Meijer M.D.
    View author publications

    You can also search for this author in PubMed Google Scholar

  10. B. J. Slotman M.D., Ph.D.
    View author publications

    You can also search for this author in PubMed Google Scholar

  11. W. P. Vandertop M.D.,Ph.D.
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to D. R. Buis M.D..

Additional information

This manuscript was presented at the 56th Annual Meeting of the Congress of Neurological Surgeons, Chicago, IL, October 2006.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Buis, D.R., Dirven, C.M.F., Lagerwaard, F.J. et al. Radiosurgery of brain arteriovenous malformations in children. J Neurol 255, 551–560 (2008). https://doi.org/10.1007/s00415-008-0739-4

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00415-008-0739-4

Key words

Search

Navigation