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Child's Nervous System
Published in: Child's Nervous System 10/2010

01-10-2010 | Special Annual Issue

Radiosurgical management of pediatric arteriovenous malformations

Authors: Douglas Kondziolka, Hideyuki Kano, Huai-che Yang, John C. Flickinger, L. Lunsford

Published in: Child's Nervous System | Issue 10/2010

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Abstract

Purpose

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.

Conclusion

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.
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Metadata
Title
Radiosurgical management of pediatric arteriovenous malformations
Authors
Douglas Kondziolka
Hideyuki Kano
Huai-che Yang
John C. Flickinger
L. Lunsford
Publication date
01-10-2010
Publisher
Springer-Verlag
Published in
Child's Nervous System / Issue 10/2010
Print ISSN: 0256-7040
Electronic ISSN: 1433-0350
DOI
https://doi.org/10.1007/s00381-010-1207-x

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