Gamma knife radiosurgery for cerebral arteriovenous malformations in children/adolescents and adults. Part I: Differences in epidemiologic, morphologic, and clinical characteristics, permanent complications, and bleeding in the latency period.
OBJECTIVE
To compare the epidemiologic, morphologic, and clinical characteristics of 92 children/adolescents (Group A) and 362 adults (Group B) with cerebral arteriovenous malformations (cAVMs) considered suitable for radiosurgery; to correlate radiosurgery-related permanent complication and post-radiosurgery bleeding rates in the 75 children/adolescents and 297 adults available for follow-up.


METHODS
Radiosurgery was performed with a model C 201-source Co60 Leksell Gamma Unit (Elekta Instruments, Stockholm, Sweden). Fisher exact two-tailed, Wilcoxon rank-sum, and two-sample binomial exact tests were used for statistical analysis.


RESULTS
There were significant differences between the two populations in sex (p = 0.015), clinical presentation (p = 0.001), and location (p = 0.008). The permanent complication rate was lower in younger (1.3%) than in older patients (5.4%), although the difference was not significant (p = 0.213). The postradiosurgery bleeding rate was lower in Group A (1.3%) than in Group B (2.7%) (p = 0.694), with global actuarial bleeding rates of 0.56% per year and 1.15% per year, respectively.


CONCLUSIONS
The different characteristics of child/adolescent and adult cAVMs suggest that they should be considered two distinct vascular disorders. The similar rates of radiosurgery-related complications and latency period bleeding in the two populations show that gamma knife radiosurgery does not expose young patients to a higher risk of sequelae than that for older patients.
Nicolato
Antonio
A
Department of Neurosurgery, University of Verona and University Hospital, Verona, Italy. antonio.nicolato@mail.azosp.vr.it
Lupidi
Francesco
F
Sandri
Marco F
MF
Foroni
Roberto
R
Zampieri
Piergiuseppe
P
Mazza
Carlo
C
Maluta
Sergio
S
Beltramello
Alberto
A
Gerosa
Massimo
M
D000293:Adolescent; D000328:Adult; D000367:Age Factors; D000368:Aged; D002543:Cerebral Hemorrhage / Q000453:epidemiology / Q000209:etiology; D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D002538:Intracranial Arteriovenous Malformations / Q000453:epidemiology / Q000473:pathology / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D019106:Postoperative Hemorrhage / Q000453:epidemiology / Q000209:etiology; D016634:Radiosurgery / Q000009:adverse effects; D012189:Retrospective Studies