title: Gamma Knife surgery for intracranial arteriovenous malformations in children: a retrospective study in 103 patients.
abstract: OBJECTIVE
  This retrospective study was designed to study the outcome in children with intracranial arteriovenous malformations (AVMs) treated with Gamma Knife surgery (GKS).
  
  
  METHODS
  One hundred and forty-two children were treated with GKS at the authors' institution between April 1997 and March 2006; of these, 103 patients with a mean follow-up of 26.4 months (range 6-96 months) were included. The mean age at presentation was 13.9 years (range 3-18 years). Eighty-six (83%) patients presented with hemorrhage. In 57 children the AVMs were Spetzler-Martin Grade I or II, and in 46 the AVMs were Grades III, IV, or V. The mean volume of the AVMs was 2.4 ml (range 0.04-23.3 ml). The mean marginal dose administered was 24.4 Gy (range 15-27 Gy). Follow-up angiography was advised at 2 years after GKS and yearly thereafter. In patients with residual AVMs, follow-up angiography was advised yearly until 4 years after GKS. If residual AVM was present, even on a follow-up angiogram obtained 4 years postsurgery, the GKS was considered a failure.
  
  
  RESULTS
  Complete obliteration of the AVM was documented in 34 (87%) of the 39 patients with complete angiographic follow-up. The 3- and 4-year actuarial rates of nidus obliteration were 66 and 86% respectively. Three patients (2.9%) experienced bleeding during the latency period, and symptomatic radiation-induced edema was noted in four patients (3.8%). A significantly higher incidence of radiation edema was noted in patients with AVM volumes greater than 3 ml and in patients with Spetzler-Martin Grade IV and V AVMs.
  
  
  CONCLUSIONS
  Gamma Knife radiosurgery is an effective modality for the treatment of intracranial AVMs in children, yielding high obliteration rates and low complication rates.
authors.affiliation: Department of Neurosurgery, All India Institute of Medical Sciences, New Delhi, India.
authors.forename: Narayanam Anantha Sai
authors.initials: NA
authors.lastname: Kiran
authors.forename: Shashank Sharad
authors.initials: SS
authors.lastname: Kale
authors.forename: Sandeep
authors.initials: S
authors.lastname: Vaishya
authors.forename: Manish Kumar
authors.initials: MK
authors.lastname: Kasliwal
authors.forename: Aditya
authors.initials: A
authors.lastname: Gupta
authors.forename: Manish Singh
authors.initials: MS
authors.lastname: Sharma
authors.forename: Bhavani Shankar
authors.initials: BS
authors.lastname: Sharma
authors.forename: Ashok Kumar
authors.initials: AK
authors.lastname: Mahapatra
mesh_terms: D000293:Adolescent; D001929:Brain Edema / Q000209:etiology; D002533:Cerebral Angiography; D002543:Cerebral Hemorrhage / Q000453:epidemiology; D002648:Child; D002675:Child, Preschool; D004621:Embolization, Therapeutic / Q000009:adverse effects; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007194:India; D002538:Intracranial Arteriovenous Malformations / Q000601:surgery*; D008279:Magnetic Resonance Imaging; D008297:Male; D016634:Radiosurgery / Q000009:adverse effects / Q000706:statistics & numerical data; D012189:Retrospective Studies; D018570:Risk Assessment; D016896:Treatment Outcome