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Gamma Knife Radiosurgery for Pediatric Arteriovenous Malformations: A Canadian Experience

  • Fred A. Zeiler (a1), Maciej K. Janik (a2), Patrick J. McDonald (a1), Anthony M. Kaufmann (a1), Derek Fewer (a1), Jim Butler (a3), Garry Schroeder (a3) and Michael West (a1)...

Abstract

Background: Gamma Knife (GK) radiosurgery for pediatric arteriovenous malformations (AVM) of the brain presents a non-invasive treatment option. We report our institutional experience with GK for pediatric AVMs. Methods: We performed a retrospective review of all pediatric patients treated with GK for cerebral AVMs at our institution from November 2003 up to and including September 2014. Patient demographics, AVM characteristics, treatment parameters and AVM responses were recorded. Results: Nineteen patients were treated, with 4 lost to follow-up. The mean age was 14.2 years (range. 7-18 years), with 10 being males (52.6%). The mean AVM diameter and volume were 2.68 cm and 3.10 cm3 respectively. The mean Spetzler-Martin (SM) and Pollock grades of the treated AVMs were 2.4 and 0.99 respectively. The mean follow-up was 62 months. All AVMs treated demonstrated a response on follow-up imaging. Nine of 15 (60.0%) patients displayed obliteration of their AVMs. Nine of 11 patients with a minimum of 3 years follow-up (81.8%) displayed obliteration, with SM and Pollock grades correlating to the chance of obliteration in this group. Two patients developed post-GK edema requiring short course dexamethasone therapy. No other major complications occurred. No permanent complications occurred. Conclusions: GK radiosurgery for pediatric AVMs offers a safe and effective treatment option, with low permanent complication rates during early follow-up.

Expérience canadienne de la radiochirurgie par scalpel gamma utilisée dans le traitement de malformations artérioveineuses chez l’enfant. Contexte : La radiochirurgie par scalpel gamma (SG) constitue une option de traitement non-invasive pour les malformations artérioveineuses (MAV) chez l’enfant. Nous rapportons notre expérience de l’utilisation du SG pour traiter des MAV chez des enfants dans notre institution. Méthode : Nous avons effectué une revue rétrospective de tous les dossiers de patients d’âge pédiatrique traités par SG pour une MAV dans notre institution entre novembre 2003 et septembre 2014 inclusivement. Nous avons relevé les données démographiques des patients, les caractéristiques des MAV, les paramètres de traitement et les résultats obtenus. Résultats : Dix-neuf patients ont été traités, dont 4 ont été perdus au suivi. L’âge moyen des patients était de 14,2 ans (écart de 7 à 18 ans) et 10 d’entre eux étaient des garçons (52,6%). Le diamètre moyen de la MAV et son volume étaient de 2,68 cm et 3,10 cm3 respectivement. Le grade moyen à l’échelle Spetzler-Martin (SM) et à l’échelle Pollock des MAV traitées étaient de 2,4 et 0,99 respectivement. Le suivi moyen était de 62 mois. À l’imagerie, une réponse au traitement était évidente au niveau de toutes les MAV traitées. Chez 9 patients sur 15 (60%) la MAV était oblitérée. Chez 9 patients sur 11, après un suivi minimum de 3 ans (81,8%), l’oblitération a été constatée avec des grades de SM et de Pollock compatibles avec une oblitération chez ce groupe de patients. Deux patients ont présenté de l’œdème après la radiochirurgie par SG nécessitant un traitement de courte durée par la dexaméthasone. Aucune autre complication majeure n’a été constatée et aucune complication permanente n’est survenue. Conclusions : La radiochirurgie par SG chez les enfants atteints de MAV constitue une option de traitement sûre et efficace comportant un faible taux de complications permanentes tôt au cours du suivi.

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Copyright

Corresponding author

Correspondence to: Frederick A. Zeiler, Neurosurgery, Health Sciences Center, University of Manitoba, GB-134, 820 Sherbrook Street, Winnipeg, Manitoba, R3A1R9. Email: umzeiler@cc.umanitoba.ca

References

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Keywords

Gamma Knife Radiosurgery for Pediatric Arteriovenous Malformations: A Canadian Experience

  • Fred A. Zeiler (a1), Maciej K. Janik (a2), Patrick J. McDonald (a1), Anthony M. Kaufmann (a1), Derek Fewer (a1), Jim Butler (a3), Garry Schroeder (a3) and Michael West (a1)...

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