Leksell gamma knife radiosurgery for cerebral arteriovenous malformations in pediatric patients.
OBJECTIVE
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.


CONCLUSIONS
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.
Nicolato
Antonio
A
Department of Neurosurgery, University Hospital, Piazzale Stefani 1, Verona, Italy. antonio.nicolato@mail.azosp.vr.it
Foroni
Roberto
R
Seghedoni
Andrea
A
Martines
Valentina
V
Lupidi
Francesco
F
Zampieri
Piergiuseppe
P
Sandri
Marco F
MF
Ricci
Umberto
U
Mazza
Carlo
C
Beltramello
Alberto
A
Gerosa
Massimo
M
Bricolo
Albino
A
D000293:Adolescent; D002533:Cerebral Angiography / Q000379:methods; D002543:Cerebral Hemorrhage / Q000601:surgery; D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D002538:Intracranial Arteriovenous Malformations / Q000503:physiopathology / Q000601:surgery*; D008297:Male; D011183:Postoperative Complications; D016634:Radiosurgery / Q000379:methods*; D012189:Retrospective Studies; D016896:Treatment Outcome