Long-Term Outcomes for Arteriovenous Malformations treated with LINAC-based Stereotactic Radiosurgery in the Pediatric Population

OBJECTIVEContrary to the better described obliteration- and hemorrhage-related data after stereotactic radiosurgery (SRS) of brain arteriovenous malformations (AVMs) in pediatric patients, estimates of the rarer complications, including cyst and tumor formation, are limited in the literature. The aim of the present study was to assess the long-term outcomes and risks of SRS for AVMs in pediatric patients (age < 18 years).METHODSThe authors retrospectively analyzed the International Radiosurgery Research Foundation pediatric AVM database for the years 1987 to 2018. AVM obliteration, post-SRS hemorrhage, cyst formation, and tumor formation were assessed. Cumulative probabilities, adjusted for the competing risk of death, were calculated.RESULTSThe study cohort comprised 539 pediatric AVM patients (mean follow-up 85.8 months). AVM obliteration was observed in 64.3% of patients, with cumulative probabilities of 63.6% (95% CI 58.8%–68.0%), 77.1% (95% CI 72.1%–81.3%), and 88.1% (95% CI 82.5%–92.0%) over 5, 10, and 15 years, respectively. Post-SRS hemorrhage was observed in 8.4% of patients, with cumulative probabilities of 4.9% (95% CI 3.1%–7.2%), 9.7% (95% CI 6.4%–13.7%), and 14.5% (95% CI 9.5%–20.5%) over 5, 10, and 15 years, respectively. Cyst formation was observed in 2.1% of patients, with cumulative probabilities of 5.5% (95% CI 2.3%–10.7%) and 6.9% (95% CI 3.1%–12.9%) over 10 and 15 years, respectively. Meningiomas were observed in 2 patients (0.4%) at 10 and 12 years after SRS, with a cumulative probability of 3.1% (95% CI 0.6%–9.7%) over 15 years.CONCLUSIONSAVM obliteration can be expected after SRS in the majority of the pediatric population, with a relatively low risk of hemorrhage during the latency period. Cyst and benign tumor formation after SRS can be observed in 7% and 3% of patients over 15 years, respectively. Longitudinal surveillance for delayed neoplasia is prudent despite its low incidence.

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Long-term Outcomes of Stereotactic Radiosurgery for Arteriovenous Malformations in the Thalamus

Neurosurgery ◽

10.1227/01.neu.0000371989.90956.6f ◽

2010 ◽

Vol 67 (2) ◽

pp. 398-403 ◽

Cited By ~ 12

Author(s):

Tomoyuki Koga ◽

Masahiro Shin ◽

Keisuke Maruyama ◽

Atsuro Terahara ◽

Nobuhito Saito

Keyword(s):

Stereotactic Radiosurgery ◽

Arteriovenous Malformations ◽

Morbidity Rate ◽

Long Term Outcomes ◽

Surgical Morbidity ◽

Obliteration Rate ◽

Planning Software ◽

Risk Of Hemorrhage

Abstract BACKGROUND Arteriovenous malformations (AVMs) in the thalamus carry a high risk of hemorrhage. Although stereotactic radiosurgery (SRS) is widely accepted because of the high surgical morbidity and mortality of these lesions, precise long-term outcomes are largely unknown. OBJECTIVE To review our experience with SRS for thalamic AVMs based on the latest follow-up data. METHODS Forty-eight patients with thalamic AVMs were treated by SRS using the Leksell Gamma Knife and were followed. Long-term outcomes including the obliteration rate, hemorrhage after treatment, and adverse effects were retrospectively analyzed. RESULTS The annual hemorrhage rate before SRS was 14%. The mean follow-up period after SRS was 66 months (range 6–198 months). The actuarial obliteration rate confirmed by angiography was 82% at 5 years after treatment, and the annual hemorrhage rate after SRS was 0.36%. Factors associated with higher obliteration rates were previous hemorrhage (P = .004) and treatment using new planning software (P = .001). Persistent worsening of neurological symptoms was observed in 17% and more frequently seen in patients who were treated using older planning software (P = .04) and a higher margin dose (P = .02). The morbidity rate for patients who received treatment planned using new software with a margin dose not more than 20 Gy was 12%. CONCLUSION SRS for thalamic AVMs achieved a high obliteration rate and effectively decreased the risk of hemorrhage, with less morbidity compared with other modalities. Longer follow-up to evaluate the risk of delayed complications and the effort to minimize the morbidity is necessary.

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Long-term Outcomes of Gamma Knife Stereotactic Radiosurgery for Arteriovenous Malformation in a Pediatric Population

Surgery for Cerebral Stroke ◽

10.2335/scs.45.243 ◽

2017 ◽

Vol 45 (4) ◽

pp. 243-250

Author(s):

Hirotaka HASEGAWA ◽

Shunya HANAKITA ◽

Masahiro SHIN ◽

Tomoyuki KOGA ◽

Wataru TAKAHASHI ◽

...

Keyword(s):

Arteriovenous Malformation ◽

Stereotactic Radiosurgery ◽

Gamma Knife ◽

Pediatric Population ◽

Long Term Outcomes ◽

Gamma Knife Stereotactic Radiosurgery

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Stereotactic Radiosurgery for Pediatric Brain Arteriovenous Malformations: Long-Term Outcomes

Neurosurgery ◽

10.1093/neuros/nyz310_107 ◽

2019 ◽

Vol 66 (Supplement_1) ◽

Author(s):

Ching-Jen Chen ◽

Cheng-Chia Lee ◽

Kathryn N Kearns ◽

Dale Ding ◽

Douglas Kondziolka ◽

...

Keyword(s):

Stereotactic Radiosurgery ◽

Arteriovenous Malformations ◽

Cyst Formation ◽

Tumor Formation ◽

Cumulative Probability ◽

Long Term Outcomes ◽

Risk Of Death ◽

Brain Arteriovenous Malformations ◽

Cumulative Probabilities

Abstract INTRODUCTION Contrary to the better described obliteration and hemorrhage data after stereotactic radiosurgery (SRS) treatment of brain arteriovenous malformations (AVMs) in pediatric patients, estimates of the rarer complications including cyst and tumor formation are limited in the literature. The aim of the study was to assess the long-term outcomes and risks of SRS for AVMs in pediatric (age < 18 yr) patients. METHODS We retrospectively analyzed the International Radiosurgery Research Foundation pediatric AVM database from 1987 to 2018. AVM obliteration, post-SRS hemorrhage, cyst formation, and tumor formation were assessed. Cumulative probabilities, adjusted for competing risk of death, were calculated. RESULTS The study cohort comprised 539 pediatric AVM patients (mean follow-up: 85.8 mo). AVM obliteration was observed in 64.3% of patients, with cumulative probabilities of 63.6% (95% CI: 58.8%-68.0%), 77.1% (95% CI: 72.1%-81.3%), and 88.1% (95% CI: 82.5%-92.0%) over 5, 10, and 15 yr, respectively. Post-SRS hemorrhage was observed in 8.4% of patients, with cumulative probabilities of 4.9% (95% CI: 3.1%-7.2%), 9.7% (95% CI: 6.4%-13.7%), and 14.5% (95% CI: 9.5%-20.5%) over 5, 10, and 15 yr, respectively. Cyst formation was observed in 2.1% of patients, with cumulative probabilities of 5.5% (95% CI: 2.3%-10.7%) and 6.9% (95% CI: 3.1%-12.9%) over 10 and 15 yr, respectively. Meningioma was observed in 2 patients (0.4%) at 10 and 12 yr after SRS, with cumulative probability of 3.1% (95% CI: 0.6%-9.7%) over 15 yr. CONCLUSION AVM obliteration can be expected after SRS in the majority of the pediatric population, with a relatively low risk of hemorrhage during the latency period. Cyst and benign tumor formation after SRS can be observed in 7% and 3% of patients over 15 yr, respectively. Longitudinal surveillance for delayed neoplasia is prudent despite its low incidence.

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Long-term outcomes of 170 brain arteriovenous malformations treated by frameless image-guided robotic stereotactic radiosurgery

Medicine ◽

10.1097/md.0000000000025752 ◽

2021 ◽

Vol 100 (19) ◽

pp. e25752

Author(s):

Pritsana Punyawai ◽

Nicha Radomsutthikul ◽

Mantana Dhanachai ◽

Chai Kobkitsuksakul ◽

Ake Hansasuta

Keyword(s):

Stereotactic Radiosurgery ◽

Arteriovenous Malformations ◽

Long Term Outcomes ◽

Image Guided ◽

Brain Arteriovenous Malformations

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Skull base aneurysmal bone cyst presenting with hydrocephalus: progressive residuum obliterated by Gamma Knife stereotactic radiosurgery in a pediatric patient

Journal of Neurosurgery Pediatrics ◽

10.3171/2020.2.peds19755 ◽

2020 ◽

Vol 26 (1) ◽

pp. 76-81

Author(s):

George H. Tse ◽

Feng Y. Jiang ◽

Matthias W. R. Radatz ◽

Saurabh Sinha ◽

Hesham Zaki

Keyword(s):

Skull Base ◽

Stereotactic Radiosurgery ◽

Gamma Knife ◽

Pediatric Population ◽

Bone Cyst ◽

Disease Free Survival ◽

Long Term Follow Up ◽

Aneurysmal Bone Cysts ◽

Gamma Knife Stereotactic Radiosurgery

Aneurysmal bone cysts (ABCs) are an uncommon entity predominantly encountered in the pediatric population. The skull is rarely involved, but these cysts have been reported to arise in the skull base. Traditional treatment has been with surgery alone; however, there is a gathering body of literature that reports alternative treatments that can achieve long-term disease-free survival. However, these therapies are predominantly directed at peripheral skeletal lesions. To the authors’ knowledge, this report is the first to describe long-term follow-up of the efficacy of Gamma Knife stereotactic radiosurgery for treatment of ABC residuum in the skull base that resulted in long-term patient stability and likely ABC obliteration.

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The long-term outcomes of radiosurgery for arteriovenous malformations in pediatric and adolescent populations

Journal of Neurosurgery Pediatrics ◽

10.3171/2015.1.peds14407 ◽

2015 ◽

Vol 16 (2) ◽

pp. 222-231 ◽

Cited By ~ 29

Author(s):

Shunya Hanakita ◽

Tomoyuki Koga ◽

Masahiro Shin ◽

Hiroshi Igaki ◽

Nobuhito Saito

Keyword(s):

Adverse Events ◽

Arteriovenous Malformations ◽

Therapeutic Option ◽

Long Term Outcomes ◽

Bleeding Rate ◽

Study Institute ◽

Delayed Complications ◽

Risk Of Hemorrhage

OBJECT Although stereotactic radiosurgery (SRS) has been accepted as a therapeutic option for arteriovenous malformations (AVMs) in children and adolescents, substantial data are still lacking regarding the outcomes of SRS for AVMs in this age group, especially long-term complications. This study aimed to clarify the long-term outcomes of SRS for the treatment of AVM in pediatric patients aged ≤ 18 years. METHODS Outcomes of 116 patients who were aged 4–18 years when they underwent SRS between 1990 and 2009 at the study institute were analyzed retrospectively. RESULTS The median follow-up period after SRS was 100 months, with 6 patients followed up for more than 20 years. Actuarial obliteration rates at 3 and 5 years after SRS were 68% and 88%, respectively. Five hemorrhages occurred in 851 patient-years of follow-up. The annual bleeding rate after SRS before obliteration was calculated as 1.3%, which decreased to 0.2% after obliteration. Shorter maximum nidus diameter (p = 0.02) and higher margin dose (p = 0.03) were associated with a higher obliteration rate. Ten patients experienced adverse events after SRS. Of them, 4 patients presented with delayed complications years after SRS (range 9–20 years after SRS). CONCLUSIONS SRS can reduce the risk of hemorrhage in pediatric and adolescent AVMs, with an acceptable risk of complications in the long term. However, adverse events such as expanding hematoma and radiation necrosis that can occur after substantial follow-up should be taken into account at the time that treatment decisions are made and informed consent is obtained.

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