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Child's Nervous System
Published in: Child's Nervous System 12/2017

01-12-2017 | Original Paper

Clinical outcomes and radiosurgical considerations for pediatric arteriovenous malformation: influence of clinical features on obliteration rate

Authors: Chang Kyu Park, Seok Keun Choi, Sung Ho Lee, Man Kyu Choi, Young Jin Lim

Published in: Child's Nervous System | Issue 12/2017

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Abstract

Purpose

Gamma knife radiosurgery (GKRS) is an established treatment modality for brain arteriovenous malformation (AVM), but there have been few published studies examining the relationship between clinical features of AVM and successful obliteration with GKRS in pediatric patients. In the current study, we investigate the outcomes of GKRS for pediatric patients with brain AVM and analyze the variables that influence obliteration.

Methods

We analyzed 68 pediatric patients (≤ 18 years) with a mean follow-up period of 61.9 months (range 6–215 months). The following parameters were analyzed to determine their influence on obliteration of AVM treated by GKRS: age, sex, target volume, irradiation dose, prior treatment, location of AVM, nidus structure, velocity of AVM, location of venous drainage, number of feeding arteries, and initial presenting symptoms. Also, we estimated clinical factors which should be considered during the follow-up period.

Results

Of the 68 patients, complete obliteration was confirmed in 26 (38.2%) by cerebral angiography. The response rate of AVM for GKRS was 92.6%. No significant association was observed between any of the parameters investigated and the obliteration of AVM, with the exception of number of feeding arteries, which exhibited a statistically significant difference by univariate analysis (p = 0.003). However, on multivariate analysis, nidus structure (p = 0.007), velocity of the main arterial phase (p = 0.013), velocity of the feeding artery phase (p = 0.004), and the number of feeding arteries (p = 0.018) showed statistical significance.

Conclusion

GKRS yielded good long-term clinical outcomes in most pediatric patients. Multiple arterial feeding vessels, diffuse nidus structure, and fast flow of AVM were specific factors associated with a low rate of obliteration in pediatric AVMs.
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Metadata
Title
Clinical outcomes and radiosurgical considerations for pediatric arteriovenous malformation: influence of clinical features on obliteration rate
Authors
Chang Kyu Park
Seok Keun Choi
Sung Ho Lee
Man Kyu Choi
Young Jin Lim
Publication date
01-12-2017
Publisher
Springer Berlin Heidelberg
Published in
Child's Nervous System / Issue 12/2017
Print ISSN: 0256-7040
Electronic ISSN: 1433-0350
DOI
https://doi.org/10.1007/s00381-017-3579-7

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