Gamma Knife surgery for pediatric arteriovenous malformations: A 25-year retrospective study
Journal of Neurosurgery: Pediatrics, ISSN: 1933-0707, Vol: 10, Issue: 5, Page: 445-450
2012
- 46Citations
- 52Captures
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Example: if you select the 1-year option for an article published in 2019 and a metric category shows 90%, that means that the article or review is performing better than 90% of the other articles/reviews published in that journal in 2019. If you select the 3-year option for the same article published in 2019 and the metric category shows 90%, that means that the article or review is performing better than 90% of the other articles/reviews published in that journal in 2019, 2018 and 2017.
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Metrics Details
- Citations46
- Citation Indexes44
- 44
- CrossRef41
- Policy Citations2
- Policy Citation2
- Captures52
- Readers52
- 52
Article Description
Object. The authors present their 25-year experience in treating pediatric arteriovenous malformations (AVMs) to allow comparisons with other historic studies and data in adults. Methods. Data were collected from a prospectively maintained departmental database selected for age and supplemented by case note review and telephone interviews as appropriate. Results. Three hundred sixty-three patients, ages 1-16 years (mean ± SD, 12 ± 3.2 years), underwent 410 treatments; 4 had planned 2-stage treatments and 43 were retreated subsequent to an initial partial response. Fifty-eight percent received general anesthesia for the procedure. Sixteen percent had previously undergone embolization. The most common presenting symptoms were as follows: hemorrhage (80.2%), epilepsy (8.3%; overall seizure prevalence 19.9%), and migrainous headaches (6.3%). Only 0.28% of the AVMs were incidental findings. The mean lesion volume was 3.75 ± 5.3 cm (range 0.01-32.8 cm), with a median Spetzler-Martin grade of III (range I-V). The mean peripheral (therapeutic) dose was 22.7 ± 2.3 Gy (range 15-25 Gy), corresponding to a mean maximum dose of 43.6 ± 6 Gy (range 25-51.4 Gy). The obliteration rate was 71.3% in patients who received one treatment and 62.5% for retreated patients, with a mean obliteration time of 32.4 and 79.6 months, respectively. The overall obliteration rate was 82.7%. No follow-up data are as yet available for the 4 patients who underwent the staged treatments. Only 4 patients received peripheral doses below 20 Gy, and the AVM was obliterated in 3 of these patients. The other patients received 20, 22.5, or 25 Gy and had obliteration rates of 82.6%, 77.7%, and 86.3%, respectively. The bleeding rate postradiosurgery was 2.2%, and the cumulative complication rate was 3.6%, with radionecrosis being the most common complication (1.1%). Conclusions. Surprisingly, there was no correlation (p = 0.43) between outcome and radiosurgical dose when that dose was between 20 and 25 Gy, thus suggesting that the lower of these 2 doses may be effective. Radiosurgery for pediatric AVM is safe and effective. © 1944-2012 American Association of Neurological Surgeons.
Bibliographic Details
http://www.scopus.com/inward/record.url?partnerID=HzOxMe3b&scp=84868341250&origin=inward; http://dx.doi.org/10.3171/2012.8.peds1241; http://www.ncbi.nlm.nih.gov/pubmed/22938080; http://thejns.org/doi/10.3171/2012.8.PEDS1241; http://thejns.org/doi/pdf/10.3171/2012.8.PEDS1241; https://thejns.org/view/journals/j-neurosurg-pediatr/10/5/article-p445.xml
Journal of Neurosurgery Publishing Group (JNSPG)
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