[Radiosurgery of cerebral arteriovenous malformations in children].

BACKGROUND AND PURPOSE

Radiosurgery has been used in a few cases of cerebral arteriovenous malformations in children. From data of our series and from literature, we tried to determine the place of this therapeutic modality for treatment of pediatric cAVMs.

PATIENTS AND METHOD

From the whole series of 705 patients treated by radiosurgery between January 84 and December 1998, 55 were under 15 years of age. Revelation mode was hemorrhage (70.9%), seizures (12.7%), headaches (10.9%) and neurological progressive deficits (1.8%). Size ranged from 5 to 50 mm (mean: 22 mm) and volume ranged from 1 to 16 cc (mean: 4 cc). Treatments prior radiosurgery were embolization alone (28%), surgery alone (16.7%), embolization plus surgery (5.5%). Distribution of cerebral arteriovenous malformations according to Spetzler & Martin's grading were 10% in grade I, 35% in grade II, 40% in grade III, 15% in grade IV and 0% in grade V.

RESULTS

Overall obliteration rate was 59% with an exaustibility rate of 80%. Obliteration rate was dependent on size and volume (100% for<1 cc cerebral arteriovenous malformations sized, 73% from 1-4 cc, 40% from 4-10 cc and 100% (but n=1)>10 cc; p=0.019), sex (84.2% for boys and 40% for girls), of angioarchitecture and Dmin (p=0.01). After multivariate analysis, only Dmin was nearly correlated with the obliteration rate (b=0.462 7; SE=0.244 0; p=0.057). Actuarial risk of hemorrhage was 2.12% per year per patient. Patients with seizures were seizure-free without any drugs after radiosurgery in 80% of cases. Parenchymal changes were mainly hypersignals spT2 in MRI.

CONCLUSION

Radiosurgery seems to be an efficient treatment with a low morbidity for cerebral arteriovenous malformations in children.