Related Experiment Video
Updated: Jul 6, 2026
Comprehensive Endovascular and Open Surgical Management of Cerebral Arteriovenous Malformations
Published on: October 20, 2017
Gamma Knife surgery for cerebral arteriovenous malformations in children: a 13-year experience
David Hung-Chi Pan1, Yu-Hung Kuo, Wan-Yuo Guo
1Department of Neurosurgery, Taipei Veterans General Hospital, Taipei, Taiwan. hcpan@vghtpe.gov.tw
Insights
Gamma Knife surgery (GKS) is effective for pediatric arteriovenous malformations (AVMs), with an 81% obliteration rate. However, medium and large AVMs in children responded less effectively than in adults.
Area of Science:
- Neurosurgery
- Radiation Oncology
- Pediatric Neurology
Background:
- Cerebral arteriovenous malformations (AVMs) radiosurgery efficacy data primarily exists for adults.
- Pediatric AVM radiosurgery studies often exclude large AVMs (> 10 cm3).
- Limited data exists on radiosurgery for large pediatric AVMs.
Purpose of the Study:
- To evaluate the efficacy and safety of Gamma Knife surgery (GKS) for pediatric cerebral AVMs.
- To compare radiosurgical outcomes in pediatric versus adult AVM patients.
- To analyze the influence of AVM size on treatment outcomes in children.
Main Methods:
- Retrospective analysis of 105 pediatric patients (< 18 years) treated with GKS (1993-2006).
- Comparison with 458 adult AVM patients treated during the same period.
- Follow-up with MRI and cerebral angiography to confirm AVM obliteration.
Main Results:
- Overall AVM obliteration rate was 81% after GKS, with 65% after primary treatment.
- Obliteration rates varied by size: 91% (small), 86% (medium), 64% (large).
- Pediatric medium (3-10 cm3) and large (10-20 cm3) AVMs showed lower obliteration rates compared to adults.
Conclusions:
- Gamma Knife surgery is a safe and effective treatment for pediatric cerebral AVMs.
- Treatment efficacy is size-dependent, with smaller AVMs achieving higher obliteration rates.
- Medium and large pediatric AVMs may require further investigation due to comparatively lower efficacy than in adults.
Object:
Studies on the efficacy of arteriovenous malformation (AVM) radiosurgery have largely been conducted in the adult population. Clinically, the results may not always be applicable to pediatric patients. Moreover, studies involving the pediatric population have largely comprised small- (< 3 cm3) and medium-sized (3-10 cm3) AVMs. For large (> 10 cm3) AVMs in children, sparse radiosurgical results are available. The current study was conducted to further clarify the role of radiosurgery in the treatment of pediatric AVMs.
Methods:
A retrospective analysis was performed of data obtained in 105 pediatric patients (< 18 years of age) with cerebral AVMs treated by Gamma Knife surgery (GKS) between 1993 and 2006. For statistical comparison the authors studied data acquired in 458 adult patients with AVMs treated during the same period. The patients underwent follow-up magnetic resonance imaging at 6-month intervals. Cerebral angiography was used to confirm the obliteration of the AVM.
Results:
In pediatric patients, the AVM obliteration rate at 48 months after a primary GKS was 65%. Repeated GKS in those in whom primary treatments failed further ablated some AVMs, for an overall obliteration rate of 81%. The efficacy of GKS correlated with the size of the AVM: 91% for small, 86% for medium, and 64% for large AVMs. The treatments were associated with an 8% morbidity rate and < 1% mortality rate. Posttreatment hemorrhage occurred in 4 (4%) of 105 patients. Obliteration rates at 48 months of small and extremely large (> 20 cm3) AVMs were similar in the pediatric and adult groups, whereas AVMs between 3 and 10 cm3 responded less efficaciously in children (p = 0.042). The AVMs with volumes ranging from 10 to 20 cm3 were also associated with a lower obliteration rate in children at 48 months, but statistical significance was not reached (p = 0.279).
Conclusions:
Gamma Knife surgery is an effective and safe treatment alternative for pediatric AVMs. The medium (3-10-cm3) and large (10-20-cm3) AVMs tend to respond less efficaciously than those of comparable size in adults.
