Clinical Article
Long-term therapeutic effect of gamma knife treatment for intracranial arteriovenous malformations in children and analysis of its influencing factors
Gao Dezhi, Meng Xiangyu, Sun Shibin, Wang Meihua, Liu Ali
Published 2021-12-28
Cite as Chin J Neurosurg, 2021, 37(12): 1239-1245. DOI: 10.3760/cma.j.cn112050-20210507-00220
Abstract
ObjectiveTo evaluate the long term outcome of gamma knife radiosurgery (GKS) for the treatment of arteriovenous malformations (AVMs) in children and to explore its relevant influencing factors.
MethodsWe retrospectively studied 279 children with intracranial AVMs (age ≤ 16 years) treated at the Gamma Knife Center of Beijing Tiantan Hospital, Capital Medical University from January 1995 to December 2016. The marginal prescription dose for treatment was 12-25 Gy (median: 17.0 Gy), the central prescription dose was 19-50 Gy (median: 32.7 Gy); the volume of the malformations treated was 0.1-30.2 cm3 (median: 1.7 cm3); 54 children (19.4%) received multiple Gamma Knife treatments, of which 35 underwent repeated treatments due to residual lesion, and 19 underwent staged treatments as planned. The clinical and imaging effects of patients were followed up, and the relevant factors affecting the occlusion of AVMs were analyzed.
ResultsThe follow-up time of 279 children after treatment was 6 to 276 months (median: 49 months), of which 197 cases (70.6%) had occlusion of AVMs. The occlusion rate at 3, 5, and 8 years after treatment was 33.5% (86/257), 69.4% (154/222), 81.1% (172/212) respectively. Twenty-four children (8.6%) had 30 cases of AVM-related bleeding after treatment, and 5 cases (1.8%) died. Five cases (1.8%) had radiotherapy-related complications, 4 cases had worsening neurological dysfunction, and 1 case had long-term radiation related cystic formation. Univariate analysis showed that compared with the non-occluded group, the children in the occluded group were older, the proportions of those with the lesion volume <3 cm3, Spetzler-Martin grade of 1 to 3, radiosurgery-based AVM score ≤1.5, and marginal prescription dose ≥17 Gy were higher, and the differences were statistically significant (all P<0.05). Multivariate Cox regression analysis showed that the marginal prescription dose ≥17 Gy was an influencing factor for occlusion of AVMs (HR=1.42, 95%CI: 1.07-1.89, P=0.015).
ConclusionsThe long-term safety and efficacy of radiosurgery for intracranial AVMs in children seem good, particularly for children with small and medium-sized AVMs. The marginal prescription dose is the main factor that affects the long-term efficacy of GKS for AVMs.
Key words:
Intracranial arteriovenous malformations; Radiosurgery; Treatment outcome; Factor analysis, statistical; Long-term
Contributor Information
Gao Dezhi
Beijing Neurosurgical Institute, Capital Medical University, Beijing 100070, China
Gamma Knife Center, Beijing Tiantan Hospital, Capital Medical University, Beijing 100070, China
Meng Xiangyu
Beijing Neurosurgical Institute, Capital Medical University, Beijing 100070, China
Gamma Knife Center, Beijing Tiantan Hospital, Capital Medical University, Beijing 100070, China
Sun Shibin
Beijing Neurosurgical Institute, Capital Medical University, Beijing 100070, China
Gamma Knife Center, Beijing Tiantan Hospital, Capital Medical University, Beijing 100070, China
Wang Meihua
Beijing Neurosurgical Institute, Capital Medical University, Beijing 100070, China
Gamma Knife Center, Beijing Tiantan Hospital, Capital Medical University, Beijing 100070, China
Liu Ali
Beijing Neurosurgical Institute, Capital Medical University, Beijing 100070, China
Gamma Knife Center, Beijing Tiantan Hospital, Capital Medical University, Beijing 100070, China
