Different Radiosurgical Responses For Arteriovenous Malformations In Children And Adults

Keywords: arteriovenous malformation, gamma knife, children, outcome, vascular malformation

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     Arteriovenous malformations (AVMs) are congenital vascular lesions, which behave differently in pediatric population compared to adults.
     The authors retrospectively investigated long-term outcomes and different radiosurgical responses for pediatric and adult AVMs treated using Gamma Knife Radiosurgery (GKRS).
     Between 1997 and 2006, 372 patients were treated with GKRS for AVMs. Two hundred thirteen patients (65 children and 148 adults) who underwent at least 36 months of angiographic follow-up after GKRS were included. The median ages at the time of treatment were 14 years (range, 3-18 yr) and 34 years (range, 19-62 yr), respectively.
     The median AVM volume and median marginal dose in children group were 4.1 cm3 (range, 0.3-34.4 cm3) and 19 Gy (range, 10-23 Gy), whereas 3.8 cm3 (range, 0.2-38.5 cm3) and 18 Gy (range, 10-25 Gy) in adult group.
     The obliteration rate at the time of first angiographic follow-up was 53.8% (35/65) in children and 68.9% (102/148) in adults. (p=0.034, chi-square test) Forty-one patients (21 (32.3%) children and 20 (13.5%) adults) underwent repeated GKRS for residual AVMs. (p=0.001) The overall obliteration rate was 58.5% in children and 72.3% in adults. (p= 0.046)
     This is a retrospective study.
     Gamma Knife radiosurgery is safe and efficacious for both children and adults with AVMs.
     The differences in radiosurgical response including obliteration rate seem to show that pediatric AVMs behave differently from those in adults.


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