Radiosurgical treatment of arteriovenous malformations in a retrospective study group of 33 children: the importance of radiobiological scores
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Arteriovenous malformations’ (AVMs) obliteration depends on several factors; among the many factors that must be considered to obtain a high rate of obliteration and a low rate of complications, Flickinger-Pollock Score (FPS) seems to have an important role but still have to be validated in the pediatric population while Paddick-Conformity Index (PCI) still has no demonstration of its utility on the outcome and is considered only as a treatment quality marker.
We retrospectively analyzed 33 consecutive children (2–18 years) with an AVM, treated with stereotactic radiosurgery Gamma Knife (SRS-GK) from 2001 to 2014 in our institution. We assess angiographic (DSA) Obliteration Rate (OR) as well FPS and PCI to draw conclusions.
DSA-OR was 60.6% with a rate of hemorrhage of 0%. median target volume (TV) was 3.60 cc (mean 4.32 ± 3.63; range 0.15–14.2), median PD was 22 Gy (mean 21.4 ± 2.6; range 16.5–25). Median percentage of coverage was 98% (mean 97 ± 3; range 84–100). The median modified FPS was 0.78 (mean 0.89 ± 0.52; range 0.21–2.1) and highly correlate with OR (p = 0.01). The median PCI was 0.65 (mean 0.65 ± 0.14; range 0.34–0.95) A PCI lower than 0.57 highly correlates with final OR (p = 0.02).
SRS-GK was safe and gradually effective in children. A prescription dose-like that used in adult population (i.e. > 18 and between 20 and 25 Gy) is essential to achieve obliteration. A PD of 23 Gy and 22 Gy did impact OR, respectively (p = 0.02) and (p = 0.05). FPS and PCI are valuable scores that seem to correlate with the OR also in the pediatric population although further prospective studies are needed to confirm these observations.
KeywordsChildren Gamma knife Pediatric radiosurgery Pediatric brain malformations
Digital subtraction angiography
Paddick Conformity Index
Flickinger Pollock Score
Magnetic resonance imaging
Compliance with ethical standards
Conflict of interest
All authors certify that they have no affiliationswith or involvement in any organization or entity with any financial interest (such as honoraria; educational grants; participation in speakers’ bureaus; membership, employment, consultancies, stock ownership, or other equity interest; and expert testimony or patent-licensing arrangements) or non-financial interest (such as personal or professional relationships, affiliations, knowledge or beliefs) in the subject matter or materials discussed in this manuscript.
All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.
Informed consent was obtained from all individual participants included in the study.
- 12.Lasjaunias P, Berenstein A, Ter Brugge K (2012) Surgical Neuroangiography: 1 clinical vascular anatomy and variations. Springer, New YorkGoogle Scholar
- 19.Franzin A, Panni P, Spatola G, Vecchio AD, Gallotti AL, Gigliotti CR, Cavalli A, Donofrio CA, Mortini P (2016) Results of volume-staged fractionated Gamma Knife radiosurgery for large complex arteriovenous malformations: obliteration rates and clinical outcomes of an evolving treatment paradigm. J Neurosurg 125:104–113Google Scholar
- 23.Paddick I (2000) A simple scoring ratio to index the conformity of radiosurgical treatment plans. Technical note. J Neurosurg 93(Suppl 3):219–222Google Scholar
- 24.Potts MB, Sheth SA, Louie J, Smyth MD, Sneed PK, McDermott MW, Lawton MT, Young WL, Hetts SW, Fullerton HJ, Gupta N (2014) Stereotactic radiosurgery at a low marginal dose for the treatment of pediatric arteriovenous malformations: obliteration, complications, and functional outcomes. J Neurosurg Pediatr 14:1–11CrossRefGoogle Scholar
- 27.Starke RM, Ding D, Kano H, Mathieu D, Huang PP, Feliciano C, Rodriguez-Mercado R, Almodovar L, Grills IS, Silva D, Abbassy M, Missios S, Kondziolka D, Barnett GH, Dade Lunsford L, Sheehan JP (2016) International multicenter cohort study of pediatric brain arteriovenous malformations. Part 2: outcomes after stereotactic radiosurgery. J Neurosurg Pediatr 19(2):136–148. https://doi.org/10.3171/2016.9.PEDS16284
- 28.Cohen-Gadol AA, Pollock BE (2006) Radiosurgery for arteriovenous malformations in children. J Neurosurg 104:388–391Google Scholar
- 29.Shin M (2002) [Gamma knife radiosurgery for arteriovenous malformations: anatomy, techniques, and avoidance]. No shinkei geka. Neurol Surg 30:703–714Google Scholar
- 30.Nataf F, Schlienger M, Lefkopoulos D, Merienne L, Ghossoub M, Foulquier JN, Deniaud-Alexandre E, Mammar H, Meder JF, Turak B, Huart J, Touboul E, Roux FX (2003) Radiosurgery of cerebral arteriovenous malformations in children: a series of 57 cases. Int J Radiat Oncol Biol Phys 57:184–195CrossRefGoogle Scholar
- 38.Ditty BJ, Omar NB, Foreman PM, Miller JH, Kicielinski KP, Fisher WS 3rd, Harrigan MR (2016) Seizure outcomes after stereotactic radiosurgery for the treatment of cerebral arteriovenous malformations. J Neurosurg 1–7Google Scholar