Radiosurgical management of pediatric arteriovenous malformations.
OBJECTIVE
Hemorrhage from an arteriovenous malformation (AVM) is the commonest cause of childhood stroke. Management options for children include observation and medical management, surgical resection, endovascular embolization, or stereotactic radiosurgery, alone or in combination.


METHODS
Radiosurgery is used for high-risk malformations in critical brain locations. While this goal is being achieved, there should be limited morbidity and hopefully no mortality from hemorrhage or radiation-induced brain injury.


RESULTS
Physicians who consider AVM radiosurgery cite one or more of the following: (1) that radiosurgery is an effective therapy required for the management of deep-brain AVMs; (2) that radiosurgery is an effective therapy for residual AVMs after subtotal resection; (3) that radiosurgery is worthwhile in an attempt to lower management risks for AVMs in functional brain locations; (4) since embolization does not cure most AVMs, additional therapy such as radiosurgery may be required; and (5) microsurgical resection may not be the best choice for some children.


CONCLUSIONS
Radiosurgery is the first and only biologic AVM therapy; it represents the beginnings of future cellular approaches to vascular malformation diseases. For this reason, the future of radiosurgery may be impacted positively by the development of other biologic strategies such as brain protection or endothelial sensitization.
Kondziolka
Douglas
D
Suite B-400, Department of Neurological Surgery, University of Pittsburgh Medical Center, 200 Lothrop St., Pittsburgh, PA 15213, USA. kondziolkads@upmc.edu
Kano
Hideyuki
H
Yang
Huai-che
HC
Flickinger
John C
JC
Lunsford
L
L
D000293:Adolescent; D002533:Cerebral Angiography; D002648:Child; D002675:Child, Preschool; D004621:Embolization, Therapeutic / Q000379:methods; D006801:Humans; D002538:Intracranial Arteriovenous Malformations / Q000000981:diagnostic imaging / Q000601:surgery*; D016634:Radiosurgery / Q000379:methods* / Q000639:trends; D012189:Retrospective Studies; D016896:Treatment Outcome