Gamma Knife Radiosurgery for Pediatric Arteriovenous Malformations

ABSTRACT

OBJECTIVE: Stereotactic radiosurgery for arteriovenous malformation(AVM) is an accepted treatment option, however, few reports have been published on the results of this treatment in pediatrics. In this study, the authors describe a series of pediatric patients. METHODS: Between March 1992 and December 2000, 27 children with AVMs were treated with gamma knife radiosurgery. Follow-up information was available in 18 of these patients. The mean age at the time of initial treatment was 11.2 years(range, 7-16 years). Twelve children(66.7%) presented with hemorrhage and 6 children(33.3%) had non-hemorrhagic symptoms(seizure in 2 cases, headache in 4 cases). Eight AVMs were located in deep-seated area and 10 AVMs in cerebral hemisphere(7 cases in eloquent area, 3 cases in non-eloquent area). The mean marginal dose was 22.9Gy(range, 15-30Gy). The mean follow-up period was 52 months(range, 24-90 months). RESULTS: Complete obliteration was noted in 13 cases(72.3%), subtotal obliteration in 3 cases(16.5%) and partial obliteration in 2 cases(11.2%). One case(5.6%) suffered from rebleeding at 45 months after gamma knife radiosurgery and 2 cases(11.1%) experienced symptomatic adverse radiation effect at 1 and 10 months after gamma knife radiosugery. CONCLUSION: Gamma knife radiosurgery may be an effective treatment option for pediatric AVMs as adult AVMs. To establish the precise efficacy of radiosurgery for pediatric AVMs, wide experience and long-term follow up is mandatory.