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Comprehensive Endovascular and Open Surgical Management of Cerebral Arteriovenous Malformations
Published on: October 20, 2017
Leksell gamma knife radiosurgery for cerebral arteriovenous malformations in pediatric patients
Antonio Nicolato1, Roberto Foroni, Andrea Seghedoni
1Department of Neurosurgery, University Hospital, Piazzale Stefani 1, Verona, Italy. antonio.nicolato@mail.azosp.vr.it
Insights
Gamma knife radiosurgery (GKR) effectively treats pediatric cerebral arteriovenous malformations (cAVMs), achieving high obliteration rates with minimal permanent complications. This study supports GKR as a safe and beneficial treatment option for children.
Area of Science:
- Neurosurgery
- Radiation Oncology
- Pediatric Neurology
Background:
- Pediatric cerebral arteriovenous malformations (cAVMs) pose significant risks, including hemorrhage.
- Traditional treatment options for cAVMs can be associated with considerable morbidity.
- Gamma knife radiosurgery (GKR) has emerged as a less invasive therapeutic option.
Purpose of the Study:
- To evaluate the efficacy and safety of Gamma Knife radiosurgery (GKR) for pediatric cerebral arteriovenous malformations (cAVMs).
- To assess the complication rates, obliteration rates, and long-term outcomes of GKR in a pediatric population.
- To discuss the advantages, risks, and failures associated with GKR for cAVMs.
Main Methods:
- Retrospective analysis of 63 pediatric patients (< or =16 years) treated with GKR for cAVMs.
- Analysis included patient demographics, cAVM characteristics (volume, Spetzler-Martin grade, location), and clinical presentation (hemorrhage in 50/63).
- Follow-up included clinical assessment and serial angiography to determine obliteration rates and complications.
Main Results:
- Complete cAVM occlusion was achieved in 31 out of 39 children with >36-month follow-up (72% at 3 years, 77% at 4 years).
- GKR-related complications occurred in 2 out of 47 cases with follow-up (1 transient, 1 permanent morbidity).
- No bleeding events were observed during the latency period following GKR treatment.
Conclusions:
- Gamma knife radiosurgery demonstrates a high rate of complete obliteration for pediatric cAVMs.
- The treatment is associated with a very low frequency of permanent morbidity and no intra-latency bleeding.
- GKR is a safe and effective therapeutic option for pediatric cAVMs, encouraging its widespread application.
Objects:
The authors report their experience of gamma knife radiosurgery (GKR) in a large series of pediatric cerebral arteriovenous malformations (cAVMs). The advantages, risks and failures of this approach are presented and discussed.
Methods:
Gamma knife radiosurgery was performed on 63 children aged < or =16 years. Haemorrhage was the clinical onset in 50 out of 63 cases. The mean pre-GK cAVM volume was 3.8 cm(3). Fifty-eight out of 63 cAVMs were Spetzler-Martin grades I-III. Most lesions (47 out of 63) were in eloquent or deep-seated brain regions.
Conclusion:
Gamma knife radiosurgery-related complications occurred in 2 out of 47 cases with an available follow-up (1 had transient and 1 permanent morbidity). No bleeding occurred during the latency period. In 39 children with >36-month follow-up, complete cAVM occlusion was angiographically documented in 31, with a 3- and 4-year actuarial obliteration rate of 72 and 77% respectively. High rates of complete obliteration and very low frequency of permanent morbidity with no bleeding during the latency period encourage widespread application of GKR in the treatment of pediatric cAVMs.
