title: Role of radiosurgery in the management of cerebral arteriovenous malformations in the pediatric age group: data from a 100-patient series.
abstract: OBJECTIVE
  To assess the safety and efficacy of radiosurgery for the management of arteriovenous malformations (AVMs) in the pediatric age group.
  
  
  METHODS
  We reviewed data from 100 children (44 girls and 56 boys) presenting a total of 103 AVMs treated by linear accelerator radiosurgery between December 1988 and May 2002. The median patient age was 12 years (range, 2-16 yr). Sixty-seven AVMs (65%) were in functional locations and 30% were inoperable. The mean AVM volume was 2.8 cm3 (range, 0.9-21.3 cm3). The mean marginal dose was 23 Gy (range, 15-25 Gy) and required between one and four isocenters. Fifty patients received multimodal treatments with embolization and/or surgery before and/or after radiosurgery. Given that 16 patients underwent two sessions of radiosurgery and one patient received three sessions, a total of 119 radiosurgical treatments were delivered. We maintained our clinical and angiographic follow-up for at least 36 months after irradiation or until the complete obliteration of the AVM was confirmed by angiography (our sole end point for judging clinical efficacy). Univariate and multivariate analysis were performed to determine predictive factors for obliteration.
  
  
  RESULTS
  Complete obliteration was achieved for 72 AVMs (70%). The permanent neurological deficit rate was 5%. One patient died because of rebleeding. None of our patients presented bleeding after an angiographically verified AVM obliteration. The main predictive factors for obliteration were low AVM volume and no previous embolization. Moreover, the younger the patient, the more effective the radiosurgery seemed to be.
  
  
  CONCLUSIONS
  Radiosurgery is a safe and effective treatment for AVMs in the pediatric age group. One criterion for success was the use of a prescription dose similar to that used with adult populations.
authors.affiliation: Department of Neurosurgery, University Hospital, Lille, France. n-reyns@chru-lille.fr
authors.forename: Nicolas
authors.initials: N
authors.lastname: Reyns
authors.forename: Serge
authors.initials: S
authors.lastname: Blond
authors.forename: Jean-Yves
authors.initials: JY
authors.lastname: Gauvrit
authors.forename: Gustavo
authors.initials: G
authors.lastname: Touzet
authors.forename: Bernard
authors.initials: B
authors.lastname: Coche
authors.forename: Jean-Pierre
authors.initials: JP
authors.lastname: Pruvo
authors.forename: Patrick
authors.initials: P
authors.lastname: Dhellemmes
mesh_terms: D000293:Adolescent; D000367:Age Factors; D002648:Child; D002675:Child, Preschool; D019468:Disease Management; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D002538:Intracranial Arteriovenous Malformations / Q000453:epidemiology* / Q000473:pathology / Q000601:surgery*; D008297:Male; D016634:Radiosurgery; D012189:Retrospective Studies