Reyns Nicolas, Blond Serge, Gauvrit Jean-Yves, Touzet Gustavo, Coche Bernard, Pruvo Jean-Pierre, Dhellemmes Patrick
Department of Neurosurgery, University Hospital, Lille, France.
Neurosurgery. 2007 Feb;60(2):268-76; discussion 276. doi: 10.1227/01.NEU.0000249277.72063.BD.
To assess the safety and efficacy of radiosurgery for the management of arteriovenous malformations (AVMs) in the pediatric age group.
We reviewed data from 100 children (44 girls and 56 boys) presenting a total of 103 AVMs treated by linear accelerator radiosurgery between December 1988 and May 2002. The median patient age was 12 years (range, 2-16 yr). Sixty-seven AVMs (65%) were in functional locations and 30% were inoperable. The mean AVM volume was 2.8 cm3 (range, 0.9-21.3 cm3). The mean marginal dose was 23 Gy (range, 15-25 Gy) and required between one and four isocenters. Fifty patients received multimodal treatments with embolization and/or surgery before and/or after radiosurgery. Given that 16 patients underwent two sessions of radiosurgery and one patient received three sessions, a total of 119 radiosurgical treatments were delivered. We maintained our clinical and angiographic follow-up for at least 36 months after irradiation or until the complete obliteration of the AVM was confirmed by angiography (our sole end point for judging clinical efficacy). Univariate and multivariate analysis were performed to determine predictive factors for obliteration.
Complete obliteration was achieved for 72 AVMs (70%). The permanent neurological deficit rate was 5%. One patient died because of rebleeding. None of our patients presented bleeding after an angiographically verified AVM obliteration. The main predictive factors for obliteration were low AVM volume and no previous embolization. Moreover, the younger the patient, the more effective the radiosurgery seemed to be.
Radiosurgery is a safe and effective treatment for AVMs in the pediatric age group. One criterion for success was the use of a prescription dose similar to that used with adult populations.
评估放射外科治疗小儿年龄组动静脉畸形（AVM）的安全性和有效性。
我们回顾了1988年12月至2002年5月期间100例儿童（44例女孩和56例男孩）的数据，这些儿童共接受了103例直线加速器放射外科治疗的AVM。患者中位年龄为12岁（范围2 - 16岁）。67例AVM（65%）位于功能区，30%无法手术切除。AVM平均体积为2.8 cm³（范围0.9 - 21.3 cm³）。平均边缘剂量为23 Gy（范围15 - 25 Gy），需要1至4个等中心。50例患者在放射外科治疗之前和/或之后接受了栓塞和/或手术的多模式治疗。鉴于16例患者接受了两次放射外科治疗，1例患者接受了三次放射外科治疗，共进行了119次放射外科治疗。我们在放疗后至少进行36个月的临床和血管造影随访，或直至血管造影证实AVM完全闭塞（我们判断临床疗效的唯一终点）。进行单因素和多因素分析以确定闭塞的预测因素。
72例AVM（70%）实现了完全闭塞。永久性神经功能缺损率为5%。1例患者因再出血死亡。血管造影证实AVM闭塞后，我们的患者均未出现出血。闭塞的主要预测因素是AVM体积小和既往未行栓塞治疗。此外，患者年龄越小，放射外科治疗似乎越有效。
放射外科是小儿年龄组AVM的一种安全有效的治疗方法。成功的一个标准是使用与成人相似的处方剂量。
