Long-term outcomes and safety of Gamma Knife radiosurgery in pediatric arteriovenous malformations.

IF 1.2 4区医学 Q4 CLINICAL NEUROLOGY

Child's Nervous System Pub Date : 2025-04-15 DOI:10.1007/s00381-025-06776-7

Abhijit Goyal-Honavar, Dwarakanath Srinivas, Subhas Konar, Nishanth Sadashiva, Manish Beniwal, Andiperumal Raj Prabhuraj, Arivazhagan Arimappamagan, Kannepalli V L Narasinga Rao, Sampath Somanna

{"title":"Long-term outcomes and safety of Gamma Knife radiosurgery in pediatric arteriovenous malformations.","authors":"Abhijit Goyal-Honavar, Dwarakanath Srinivas, Subhas Konar, Nishanth Sadashiva, Manish Beniwal, Andiperumal Raj Prabhuraj, Arivazhagan Arimappamagan, Kannepalli V L Narasinga Rao, Sampath Somanna","doi":"10.1007/s00381-025-06776-7","DOIUrl":null,"url":null,"abstract":"Purpose: Despite the unique challenges presented by pediatric intracranial AVMs, little data is available on the use of GKRS in the pediatric population. Therefore, we aimed to present our experience with GKRS in treating pediatric AVMs, determining the factors that influence nidus obliteration and poor outcomes, with a focus on delayed complications.Methods: This retrospective review examined patients ≤18 years who underwent GKRS between January 2013 and December 2021 for intracranial AVMs. Factors that predicted residual nidus and poor outcomes were analyzed. The utility of AVM size reduction at follow-up in predicting eventual nidus obliteration was tested.Results: We treated 101 pediatric patients for AVMs with a mean age of 14.2 ± 2.8 years. The mean dose delivered was 22.7 ± 2.4 Gy. After a mean follow-up of 41.4 months, 78 AVMs (77.8%) were obliterated. Residual nidus was associated with prior embolization (HR 4.953; 95% CI 1.343, 18.268; p = 0.016) and age ≥14 years (HR 5.920; 95% CI 1.559, 22.480; p = 0.009) while presentation with bleed (HR 0.178; 95% CI 0.05, 0.631; p = 0.008) was protective. Reduction in size of a nidus during early follow-up closely correlated with eventual obliteration, with increasing accuracy at 6-month, 12-month, and 24-month follow-up (67.6%, 80.2%, and 86.5% respectively). Twelve patients developed perilesional edema, while one patient each developed a chronic encapsulated hematoma (CEH), cyst formation, and rebleed. Dose > 22 Gy (HR 25.641; 95% CI 2.257, 250; p = 0.009) and volume ≥ 3 cc (HR 7.189; 95% CI 1.176, 43.945; p = 0.033) predicted poor outcomes on multivariate analysis.Conclusions: GKRS delivers a high rate of AVM nidus obliteration in the pediatric population, with prior embolization, older age, and unruptured presentation associated with residual nidus. The incidence of delayed complications, although low, warrants regular surveillance in the pediatric population due to their greater life expectancy.","PeriodicalId":9970,"journal":{"name":"Child's Nervous System","volume":"41 1","pages":"157"},"PeriodicalIF":1.2000,"publicationDate":"2025-04-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Child's Nervous System","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1007/s00381-025-06776-7","RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q4","JCRName":"CLINICAL NEUROLOGY","Score":null,"Total":0}

引用次数: 0

Abstract

Purpose: Despite the unique challenges presented by pediatric intracranial AVMs, little data is available on the use of GKRS in the pediatric population. Therefore, we aimed to present our experience with GKRS in treating pediatric AVMs, determining the factors that influence nidus obliteration and poor outcomes, with a focus on delayed complications.

Methods: This retrospective review examined patients ≤18 years who underwent GKRS between January 2013 and December 2021 for intracranial AVMs. Factors that predicted residual nidus and poor outcomes were analyzed. The utility of AVM size reduction at follow-up in predicting eventual nidus obliteration was tested.

Results: We treated 101 pediatric patients for AVMs with a mean age of 14.2 ± 2.8 years. The mean dose delivered was 22.7 ± 2.4 Gy. After a mean follow-up of 41.4 months, 78 AVMs (77.8%) were obliterated. Residual nidus was associated with prior embolization (HR 4.953; 95% CI 1.343, 18.268; p = 0.016) and age ≥14 years (HR 5.920; 95% CI 1.559, 22.480; p = 0.009) while presentation with bleed (HR 0.178; 95% CI 0.05, 0.631; p = 0.008) was protective. Reduction in size of a nidus during early follow-up closely correlated with eventual obliteration, with increasing accuracy at 6-month, 12-month, and 24-month follow-up (67.6%, 80.2%, and 86.5% respectively). Twelve patients developed perilesional edema, while one patient each developed a chronic encapsulated hematoma (CEH), cyst formation, and rebleed. Dose > 22 Gy (HR 25.641; 95% CI 2.257, 250; p = 0.009) and volume ≥ 3 cc (HR 7.189; 95% CI 1.176, 43.945; p = 0.033) predicted poor outcomes on multivariate analysis.

Conclusions: GKRS delivers a high rate of AVM nidus obliteration in the pediatric population, with prior embolization, older age, and unruptured presentation associated with residual nidus. The incidence of delayed complications, although low, warrants regular surveillance in the pediatric population due to their greater life expectancy.

查看原文本刊更多论文

伽玛刀放射治疗儿童动静脉畸形的长期疗效和安全性。

目的：尽管儿科颅内avm面临着独特的挑战，但关于GKRS在儿科人群中的应用的数据很少。因此，我们的目的是介绍我们使用GKRS治疗儿童AVMs的经验，确定影响病灶闭塞和不良预后的因素，重点是延迟并发症。方法：本回顾性研究调查了2013年1月至2021年12月期间因颅内AVMs接受GKRS治疗的≤18岁的患者。分析预测病灶残留和预后不良的因素。在随访中，AVM大小缩小对预测最终病灶闭塞的效用进行了测试。结果：我们治疗了101例小儿动静脉畸形患者，平均年龄14.2±2.8岁。平均剂量为22.7±2.4 Gy。平均随访41.4个月，78例avm消失，占77.8%。残余病灶与先前栓塞相关(HR 4.953；95% ci 1.343, 18.268；p = 0.016)，年龄≥14岁(HR 5.920；95% ci 1.559, 22.480；p = 0.009)，而表现为出血(HR 0.178；95% ci 0.05, 0.631；P = 0.008)具有保护作用。在早期随访中病灶大小的减小与最终的闭塞密切相关，在6个月、12个月和24个月的随访中准确性增加（分别为67.6%、80.2%和86.5%）。12例患者出现病灶周围水肿，1例患者出现慢性囊性血肿（CEH）、囊肿形成和再出血。剂量> 22 Gy (HR 25.641；95% ci 2.257, 250；p = 0.009)，体积≥3cc (HR 7.189；95% ci 1.176, 43.945；P = 0.033)预测预后不良。结论：GKRS在儿童人群中具有较高的AVM病灶闭塞率，既往栓塞，年龄较大，未破裂表现与病灶残留相关。延迟性并发症的发生率虽然较低，但由于儿童的预期寿命较长，因此需要定期监测。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

求助全文

约1分钟内获得全文求助全文

来源期刊

Child's Nervous System 医学-临床神经学

CiteScore

3.00

自引率

7.10%

发文量

322

审稿时长

3 months

期刊介绍： The journal has been expanded to encompass all aspects of pediatric neurosciences concerning the developmental and acquired abnormalities of the nervous system and its coverings, functional disorders, epilepsy, spasticity, basic and clinical neuro-oncology, rehabilitation and trauma. Global pediatric neurosurgery is an additional field of interest that will be considered for publication in the journal.