Gamma Knife Radiosurgery for Pediatric and Adolescent Cerebral Arteriovenous Malformations: Acıbadem University Experience on 168 Patients.

Thiago Hoesker, O. ArtunçTüre, EceTek, SelçukPeker, MeriçŞengöz, Alp Dinçer,

OlcayÇizmeli, M MemetÖzek, KorayÖzduman

INTRODUCTION:

Cerebral arteriovenous malformations (AVM) are considered congenital lesions¹. However, exceptional rarity in the intrauterine period and relative rarity in the childhood period have long been puzzling facts^2,3. Brain cerebral arteriovenous malformations are the most common cause of hemorrhagic stroke in pediatric age accounting for almost 50% of intracranial hemorrhage in population until 18 years⁵.These observations suggest that either the AVM’s develop during the first decades of life or that the bleeding incidence steadily rises during this period^6-8. However, the natural history and biology of AVM’s in the first few decades of life, including their origin, growth, cerebral hemodynamic adaptation are mostly unknown.

METHODS:

This is a retrospective analysis of a single institutional cohort of 168 cerebral AVM’s in patients younger than 21 years of age who were treated with Gamma Knife radiosurgery. We retrospectively reviewed all patients with cerebral AVM treated at the Acıbadem Gamma Knife Unit from 2006 to 2020. Patients younger than 21 years were included in the analysis. Only patients for whom complete hospital records at admission, imaging studies and Gamma Knife treatment plans were available were included in the study.

RESULTS:

Follow-up information was available for 123 (73,2%) of the patients. Regarding to mortality, 2 (1,2%) patients were dead because unrelated systemic causes and were excluded from analysis. 148 (88%) AVM’s were supratentorial and 19 (11%) were infratentorial. One case was located in both compartments (combined). Among the supratentorial AVMs, 48(32,5%) had deep location and 100 (67,5%) had superficial location. For the infratentorial AVM’s 13(68,5%) were located in the cerebellum and 6(31,5%) were located in the brainstem. Among treated patients, 121 had follow-up. The average time of follow-up was 52,9 months (range 2,2-167,9 months). The AVM obliteration was achieved in 71 (58,6%) patients in our cohort. 50 (41,3%) patients had residual AVM in the control MRI

CONCLUSIONS:

Stereotactic RS appears to be an effective and safe method for treating pediatric AVMs, particularly those in deeper locations where surgery is a risk.