Gamma Knife Surgery for Pediatric Arteriovenous Malformations: Long-term Follow-up in 186 Patients

Object A relatively benign natural course of unruptured cerebral arteriovenous malformations (AVMs) has recently been recognized, and the decision to treat incidentally found AVMs has been questioned. This study aims to evaluate the long-term imaging and clinical outcomes of patients with asymptomatic, incidentally discovered AVMs treated with Gamma Knife surgery (GKS). Methods Thirty-one patients, each with an incidentally diagnosed AVM, underwent GKS between 1989 and 2009. The nidus volumes ranged from 0.3 to 11.1 cm3 (median 3.2 cm3). A margin dose between 15 and 26 Gy (median 20 Gy) was used to treat the AVMs. Four patients underwent repeat GKS for still-patent AVM residuals after the initial GKS procedure. Clinical follow-up ranged from 24 to 196 months, with a mean of 78 months (median 51 months) after the initial GKS. Results Following GKS, 19 patients (61.3%) had a total AVM obliteration on angiography. In 7 patients (22.6%), no flow voids were observed on MRI but angiographic confirmation was not available. In 5 patients (16.1%), the AVMs remained patent. A small nidus volume was significantly associated with increased AVM obliteration rate. Thirteen patients (41.9%) developed radiation-induced imaging changes: 11 were asymptomatic (35.5%), 1 had only headache (3.2%), and 1 developed seizure and neurological deficits (3.2%). Two patients each had 1 hemorrhage during the latency period (116.5 risk years), yielding an annual hemorrhage rate of 1.7% before AVM obliteration. Conclusions The decision to treat asymptomatic AVMs, and if so, which treatment approach to use, remain the subject of debate. GKS as a minimally invasive procedure appears to achieve a reasonable outcome with low procedure-related morbidity. In those patients with incidental AVMs, the benefits as well as the risks of radiosurgical intervention will only be fully defined with long-term follow-up.

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Angiographic Long-term Follow-up Data for Arteriovenous Malformations Previously Proven to Be Obliterated after Gamma Knife Radiosurgery

Neurosurgery ◽

10.1097/00006123-200004000-00006 ◽

2000 ◽

Vol 46 (4) ◽

pp. 803-810 ◽

Cited By ~ 17

Author(s):

Melker Lindqvist ◽

Bengt Karlsson ◽

Wan-Yuo Guo ◽

Lars Kihlström ◽

Bodo Lippitz ◽

...

Keyword(s):

Gamma Knife ◽

Arteriovenous Malformations ◽

Gamma Knife Radiosurgery ◽

Long Term Follow Up

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Long-Term Follow-Up of Quality of Life after Gamma Knife Radiosurgery Treatment for Arteriovenous Malformations

Radiosurgery ◽

10.1159/000093734 ◽

2006 ◽

pp. 211-220

Author(s):

Michael J. Jr. Musacchio ◽

Brian Kuchay ◽

Nimesh H. Patel ◽

Sepehr B. Sani ◽

Demetrius K. Lopes

Keyword(s):

Quality Of Life ◽

Gamma Knife ◽

Arteriovenous Malformations ◽

Gamma Knife Radiosurgery ◽

Long Term Follow Up

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Long-term follow-up study of Gamma Knife radiosurgery for arteriovenous malformations with diffuse-type nidi

Journal of the Korean Society of Stereotactic and Functional Neurosurgery ◽

10.52662/jksfn.2021.00067 ◽

2021 ◽

Author(s):

Yuwhan Chung ◽

Chang Kyu Park ◽

Seok Keun Choi ◽

Young Jin Lim

Keyword(s):

Gamma Knife ◽

Arteriovenous Malformations ◽

Gamma Knife Radiosurgery ◽

Diffuse Type ◽

Follow Up Study ◽

Long Term Follow Up

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Gamma Knife surgery for arteriovenous malformations in children

Journal of Neurosurgery Pediatrics ◽

10.3171/2010.8.peds10138 ◽

2010 ◽

Vol 6 (5) ◽

pp. 426-434 ◽

Cited By ~ 49

Author(s):

Chun Po Yen ◽

Stephen J. Monteith ◽

James H. Nguyen ◽

Jessica Rainey ◽

David J. Schlesinger ◽

...

Keyword(s):

Gamma Knife ◽

Arteriovenous Malformations ◽

Cyst Formation ◽

Gamma Knife Surgery ◽

Neurological Deficits ◽

Secondary Tumors ◽

Radiation Induced ◽

Induced Changes

Object The aim of this study was to evaluate the long-term imaging and clinical outcomes of intracranial arteriovenous malformations (AVMs) in children treated with Gamma Knife surgery (GKS). Methods Between 1989 and 2007, 200 patients with AVMs who were 18 years of age or younger were treated at the University of Virginia Health System. Excluding 14 patients who had not reached 2-year follow-up, 186 patients comprised this study. Hemorrhage was the most common presenting symptom leading to the diagnosis of AVMs (71.5%). The mean nidus volume was 3.2 cm3 at the time of GKS, and a mean prescription dose of 21.9 Gy was used. Results After initial GKS, 49.5% of patients achieved total angiographic obliteration. Forty-one patients whose AVM nidi remained patent underwent additional GKS. The obliteration rate increased to 58.6% after a second or multiple GKS. Subtotal obliteration was achieved in 9 patients (4.8%). Forty-nine patients (26.3%) still had a patent residual nidus. In 19 patients (10.2%), obliteration was confirmed on MR imaging only. Ten patients had 17 hemorrhages during the follow-up period. The hemorrhage rate was 5.4% within 2 years after GKS and 0.8% between 2 and 5 years. Six patients developed neurological deficits along with the radiation-induced changes. Two patients developed asymptomatic meningiomas 10 and 12 years after GKS. After a mean clinical follow-up of 98 months, less than 4% of patients had difficulty attending school or developing a career. Conclusions Gamma Knife surgery offers a reasonable chance of obliteration of an AVM in pediatric patients. The incidence of symptomatic radiation-induced changes is relatively low; however, long-term clinical and imaging follow-up is required to identify delayed cyst formation and secondary tumors.

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Long-term results of Gamma Knife surgery for arteriovenous malformations: 10- to 15-year follow up in patients treated with lower doses

Journal of Neurosurgery ◽

10.3171/sup.2006.105.7.64 ◽

2006 ◽

Vol 105 (Supplement) ◽

pp. 64-68 ◽

Cited By ~ 19

Author(s):

Hiroshi K. Inoue

Keyword(s):

Adverse Effects ◽

Brain Edema ◽

Gamma Knife ◽

Arteriovenous Malformations ◽

Cyst Formation ◽

Gamma Knife Surgery ◽

Surrounding Tissue ◽

Long Term Results

ObjectSeveral adverse effects such as brain edema, necrosis, arterial stenosis, hemorrhage after obliteration, and delayed cyst formation have been reported as early and late complications of Gamma Knife surgery (GKS) for arteriovenous malformations (AVMs). These adverse effects seem to be decreased in a lower-dose treatment regimen compared with the classic higher margin doses of 25 Gy because the radiation insult to the surrounding tissue is minimized. Long-term results of lower-dose GKS for AVMs are presented.MethodsOne hundred fourteen patients with AVMs were treated with lower-dose GKS (≤ 20-Gy margin dose). There were 68 male and 46 female patients, aged 10 to 68 years (mean 35.4 years). The evaluation of AVM nidi and dose planning were performed using both angiography and MR imaging in all cases to exclude the surrounding brain tissue. The mean margin dose was 19.5 Gy.Total angiographically documented obliteration was achieved in 65 (85.5%) of 76 patients. Eleven patients underwent a second treatment, including staged treatment for large AVMs; total AVM obliteration has been achieved in six of them to date. Of 38 patients in whom no follow-up examination could be performed, 19 of them were healthy and 10 were lost from follow up. Nine patients experienced bleeding during the latency period, and four of them suffered lethal hemorrhage. Symptomatic early complications were extensive brain edema after repeated GKS in one patient and an adverse effect on the internal capsule in one. Delayed cyst formation was found in one patient as a late complication 10 years after treatment. No treatment-related death has been noted to date.Conclusions Lower-dose GKS is an effective and safe treatment for patients with AVMs and may decrease long-term adverse effects to the surrounding brain.

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Gamma Knife Surgery of Meningiomas Involving the Cavernous Sinus

Neurosurgery ◽

10.1227/01.neu.0000366112.04015.e2 ◽

2010 ◽

Vol 66 (4) ◽

pp. 661-669 ◽

Cited By ~ 67

Author(s):

Bente Sandvei Skeie ◽

P. Ø. Enger ◽

G. O. Skeie ◽

F. Thorsen ◽

P-H. Pedersen

Keyword(s):

Tumor Growth ◽

Gamma Knife ◽

Cavernous Sinus ◽

Complication Rate ◽

Growth Control ◽

Gamma Knife Surgery ◽

Long Term Outcome ◽

Long Term Follow Up

Abstract OBJECTIVE Resection of meningiomas involving the cavernous sinus often is incomplete and associated with considerable morbidity. As a result, an increasing number of patients with such tumors have been treated with gamma knife surgery (GKS). However, few studies have investigated the long-term outcome for this group of patients. METHODS 100 patients (23 male/77 female) with meningiomas involving the cavernous sinus received GKS at the Department of Neurosurgery at Haukeland University Hospital, Bergen, Norway, between November 1988 and July 2006. They were followed for a mean of 82.0 (range, 0–243) months. Only 2 patients were lost to long-term follow-up. Sixty patients underwent craniotomy before radiosurgery, whereas radiosurgery was the primary treatment for 40 patients. RESULTS Tumor growth control was achieved in 84.0% of patients. Twelve patients required re-treatment: craniotomy (7), radiosurgery (1), or both (4). Three out of 5 patients with repeated radiosurgery demonstrated secondary tumor growth control. Excluding atypical meningiomas, the growth control rate was 90.4%. The 1-, 5-, and 10-year actuarial tumor growth control rates are 98.9%, 94.2%, and 91.6%, respectively. Treatment failure was preceded by clinical symptoms in 14 of 15 patients. Most tumor growths appeared within 2.5 years. Only one third grew later (range, 6–20 yr). The complication rate was 6.0%: optic neuropathy (2), pituitary dysfunction (3), worsening of diplopia (1), and radiation edema (1). Mortality was 0. At last follow-up, 88.0% were able to live independent lives. CONCLUSION GKS gives long-term growth control and has a low complication rate. Most tumor growths manifest within 3 years following treatment. However, some appear late, emphasizing the need for long-term follow-up.

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