Yeon Je Young, Shin Hyung Jin, Kim Jong-Soo, Hong Seung-Chyul, Lee Jung-Il
Department of Neurosurgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Kangnam-Gu, Seoul, 135-710, Republic of Korea.
Childs Nerv Syst. 2011 Jul;27(7):1109-19. doi: 10.1007/s00381-011-1401-5. Epub 2011 Feb 1.
The aim of this study was to evaluate clinico-radiological outcomes following gamma knife radiosurgery (GKS) for pediatric arteriovenous malformations (AVMs).
The present series included 39 children (3-17 years of age) who underwent GKS for cerebral AVMs between January 2002 and February 2008. Twenty-five patients presented with hemorrhages. The median AVM volume was 1.5 cm³, and the median marginal dose was 20 Gy. All patients continued to have follow-up for more than 24 months with serial magnetic resonance images (MRIs)/angiograms. Current school performance has been evaluated using a telephone survey answered by the patients' parents.
Follow-up angiograms, available in 34 patients, confirmed complete obliteration in 16 patients. Serial MRIs indicated obliteration of the nidus in one of five patients without angiography. The diffuse nidus structure and low marginal dose were significantly associated with incomplete obliteration. Twelve patients underwent a second GKS, and subsequent angiographies, available in six patients, demonstrated complete obliteration in two of them. Complications included new-onset seizures (n = 1), apraxia (n = 1), and temporal horn entrapment requiring a shunt operation (n = 1). School performance declined in 14 out of 32 patients. Both the AVM volume and modified AVM score were found to be reliable predictors of school performance.
The results of the present study substantiate the diffuse and other atypical features of pediatric AVMs as major determinants of treatment failure following GKS. Considering the apparent declination of school performance, future prospective studies would be required to investigate the possible late-effects of GKS on neuropsychological function.
本研究旨在评估小儿动静脉畸形（AVM）伽玛刀放射外科治疗（GKS）后的临床放射学结果。
本系列研究纳入了2002年1月至2008年2月期间接受GKS治疗脑AVM的39名儿童（3至17岁）。25例患者有出血表现。AVM体积中位数为1.5 cm³，边缘剂量中位数为20 Gy。所有患者均通过连续磁共振成像（MRI）/血管造影进行了超过24个月的随访。目前的学业表现通过患者父母回答的电话调查进行评估。
34例患者有随访血管造影，其中16例证实完全闭塞。5例未行血管造影的患者中，连续MRI显示1例病灶闭塞。弥漫性病灶结构和低边缘剂量与不完全闭塞显著相关。12例患者接受了第二次GKS，6例患者随后的血管造影显示其中2例完全闭塞。并发症包括新发癫痫（n = 1）、失用症（n = 1）和需要分流手术的颞角受压（n = 1）。32例患者中有14例学业表现下降。发现AVM体积和改良AVM评分都是学业表现的可靠预测指标。
本研究结果证实小儿AVM的弥漫性和其他非典型特征是GKS治疗失败的主要决定因素。考虑到学业表现明显下降，未来需要进行前瞻性研究以调查GKS对神经心理功能可能的晚期影响。
