title: Angiographic features help predict outcome after stereotactic radiosurgery for the treatment of pediatric arteriovenous malformations.
abstract: OBJECTIVE
  Arteriovenous malformations (AVMs) are a frequent cause of hemorrhagic stroke in children. Stereotactic radiosurgery (SRS) is an established treatment for these lesions, particularly those that are surgically inaccessible. Because only complete AVM obliteration is believed to protect against the future risk of hemorrhage, identifying lesion characteristics that predict response to therapy is an important objective. The goal of this study is to evaluate the influence of angiographic features of AVMs on the rate of obliteration following treatment with SRS.
  
  
  METHODS
  This is a retrospective cohort study of pediatric patients (age ≤18 years) treated with Gamma Knife SRS for cerebral AVMs between 2000 and 2012. Detailed angiographic data at the time of initial angiographic evaluation were prospectively recorded by experienced neurointerventional radiologists. The primary outcome was the rate of obliteration on a 3-year follow-up angiogram.
  
  
  RESULTS
  We identified 42 pediatric patients treated with SRS for cerebral AVMs. Twenty-seven patients completed 3-year angiographic follow-ups. Complete obliteration was seen in 30%, partial response in 67%, and no response in 4%. Higher SRS dose was associated with complete obliteration. Larger AVM diameter, presence of multiple draining veins, and presence of multiple draining veins reaching a sinus were associated with partial response. In this small cohort, diffuse AVM borders, presence of aneurysm, and pre-SRS embolization were not associated with obliteration.
  
  
  CONCLUSIONS
  Our study identifies AVMs in the pediatric population with a nidus diameter of <2.5 cm and a solitary draining vein as the most likely to undergo complete obliteration after SRS treatment.
authors.affiliation: Department of Neurology, University of California, San Francisco, San Francisco, CA, USA.
authors.forename: Sunil A
authors.initials: SA
authors.lastname: Sheth
authors.forename: Matthew B
authors.initials: MB
authors.lastname: Potts
authors.forename: Penny K
authors.initials: PK
authors.lastname: Sneed
authors.forename: William L
authors.initials: WL
authors.lastname: Young
authors.forename: Daniel L
authors.initials: DL
authors.lastname: Cooke
authors.forename: Nalin
authors.initials: N
authors.lastname: Gupta
authors.forename: Steven W
authors.initials: SW
authors.lastname: Hetts
mesh_terms: D002533:Cerebral Angiography; D002648:Child; D005260:Female; D006801:Humans; D002538:Intracranial Arteriovenous Malformations / Q000000981:diagnostic imaging* / Q000601:surgery*; D008297:Male; D016634:Radiosurgery; D012189:Retrospective Studies; D016896:Treatment Outcome
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