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Updated: Jun 4, 2026
Comprehensive Endovascular and Open Surgical Management of Cerebral Arteriovenous Malformations
Published on: October 20, 2017
Clinico-radiological outcomes following gamma knife radiosurgery for pediatric arteriovenous malformations
Je Young Yeon1, Hyung Jin Shin, Jong-Soo Kim
1Department of Neurosurgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Kangnam-Gu, Seoul, 135-710, Republic of Korea.
Insights
Gamma Knife Radiosurgery (GKS) for pediatric arteriovenous malformations (AVMs) showed limited obliteration rates, with diffuse AVM features predicting failure. School performance declined in many patients, necessitating further research into long-term effects.
Area of Science:
- Neurosurgery
- Pediatric Neurology
- Radiology
Background:
- Pediatric arteriovenous malformations (AVMs) pose significant neurological risks.
- Gamma Knife Radiosurgery (GKS) is a treatment option for AVMs.
Purpose of the Study:
- To evaluate clinico-radiological outcomes of GKS for pediatric AVMs.
- To assess the impact of GKS on school performance in children.
Main Methods:
- Retrospective analysis of 39 children (3-17 years) treated with GKS for cerebral AVMs.
- Follow-up included serial MRIs/angiograms and parental surveys on school performance.
- Median AVM volume was 1.5 cm³, median marginal dose 20 Gy.
Main Results:
- Complete obliteration achieved in 16 of 34 patients with available angiograms.
- Diffuse nidus structure and low marginal dose correlated with incomplete obliteration.
- School performance declined in 14/32 patients; AVM volume and score predicted performance.
Conclusions:
- Diffuse and atypical features of pediatric AVMs are key factors in GKS treatment failure.
- Further prospective studies are needed to investigate late neuropsychological effects of GKS.
Purpose:
The aim of this study was to evaluate clinico-radiological outcomes following gamma knife radiosurgery (GKS) for pediatric arteriovenous malformations (AVMs).
Methods:
The present series included 39 children (3-17 years of age) who underwent GKS for cerebral AVMs between January 2002 and February 2008. Twenty-five patients presented with hemorrhages. The median AVM volume was 1.5 cm³, and the median marginal dose was 20 Gy. All patients continued to have follow-up for more than 24 months with serial magnetic resonance images (MRIs)/angiograms. Current school performance has been evaluated using a telephone survey answered by the patients' parents.
Results:
Follow-up angiograms, available in 34 patients, confirmed complete obliteration in 16 patients. Serial MRIs indicated obliteration of the nidus in one of five patients without angiography. The diffuse nidus structure and low marginal dose were significantly associated with incomplete obliteration. Twelve patients underwent a second GKS, and subsequent angiographies, available in six patients, demonstrated complete obliteration in two of them. Complications included new-onset seizures (n = 1), apraxia (n = 1), and temporal horn entrapment requiring a shunt operation (n = 1). School performance declined in 14 out of 32 patients. Both the AVM volume and modified AVM score were found to be reliable predictors of school performance.
Conclusions:
The results of the present study substantiate the diffuse and other atypical features of pediatric AVMs as major determinants of treatment failure following GKS. Considering the apparent declination of school performance, future prospective studies would be required to investigate the possible late-effects of GKS on neuropsychological function.
