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Clinical outcomes and radiosurgical considerations for pediatric arteriovenous malformation: influence of clinical features on obliteration rate

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Abstract

Purpose

Gamma knife radiosurgery (GKRS) is an established treatment modality for brain arteriovenous malformation (AVM), but there have been few published studies examining the relationship between clinical features of AVM and successful obliteration with GKRS in pediatric patients. In the current study, we investigate the outcomes of GKRS for pediatric patients with brain AVM and analyze the variables that influence obliteration.

Methods

We analyzed 68 pediatric patients (≤ 18 years) with a mean follow-up period of 61.9 months (range 6–215 months). The following parameters were analyzed to determine their influence on obliteration of AVM treated by GKRS: age, sex, target volume, irradiation dose, prior treatment, location of AVM, nidus structure, velocity of AVM, location of venous drainage, number of feeding arteries, and initial presenting symptoms. Also, we estimated clinical factors which should be considered during the follow-up period.

Results

Of the 68 patients, complete obliteration was confirmed in 26 (38.2%) by cerebral angiography. The response rate of AVM for GKRS was 92.6%. No significant association was observed between any of the parameters investigated and the obliteration of AVM, with the exception of number of feeding arteries, which exhibited a statistically significant difference by univariate analysis (p = 0.003). However, on multivariate analysis, nidus structure (p = 0.007), velocity of the main arterial phase (p = 0.013), velocity of the feeding artery phase (p = 0.004), and the number of feeding arteries (p = 0.018) showed statistical significance.

Conclusion

GKRS yielded good long-term clinical outcomes in most pediatric patients. Multiple arterial feeding vessels, diffuse nidus structure, and fast flow of AVM were specific factors associated with a low rate of obliteration in pediatric AVMs.

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Acknowledgements

The authors thank Dr. Eui Jong Kim for his assistance in cerebral angiography interpretation.

Funding

No funding was received for this research.

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Authors and Affiliations

  1. Department of Neurosurgery, Department of Medicine, Graduate School, Kyung Hee University, 1 Hoegi-dong, Dongdaemun-gu, Seoul, 130-702, South Korea

    Chang Kyu Park, Seok Keun Choi, Sung Ho Lee, Man Kyu Choi & Young Jin Lim

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  1. Chang Kyu Park
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  2. Seok Keun Choi
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Correspondence to Seok Keun Choi.

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Conflicts of interest

The authors have no personal financial or institutional interest in any of the drugs, materials, or devices described in this article.

Ethical approval

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

Informed consent was obtained from all individual participants included in the study.

Additional information

Presentation at Conference: None

IRB Number: KMC IRB 1523-07

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Park, C.K., Choi, S.K., Lee, S.H. et al. Clinical outcomes and radiosurgical considerations for pediatric arteriovenous malformation: influence of clinical features on obliteration rate. Childs Nerv Syst 33, 2137–2145 (2017). https://doi.org/10.1007/s00381-017-3579-7

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  • DOI: https://doi.org/10.1007/s00381-017-3579-7

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