caa a22 4500 60621660X CHVBK 20210128101104.0 cr unu---uuuuu 210128e20150201xx s 000 0 eng 10.1007/s00701-014-2305-4 doi (NATIONALLICENCE)springer-10.1007/s00701-014-2305-4 Radiosurgery for unruptured cerebral arteriovenous malformations in pediatric patients [Elektronische Daten] [Dale Ding, Zhiyuan Xu, Chun-Po Yen, Robert Starke, Jason Sheehan] Background: Unruptured cerebral arteriovenous malformations (AVMs) in pediatric patients (age <18years) were excluded from A Randomized Trial of Unruptured AVMs (ARUBA). Therefore, the efficacy of radiosurgery for unruptured pediatric AVMs is poorly understood. The goal of this study is to determine the outcomes and define the predictors of obliteration following radiosurgery for unruptured AVMs in pediatric patients. Methods: We evaluated a prospective database, from 1989 to 2013, of AVM patients treated with radiosurgery at our institution. Patients with age less than 18years at the time of radiosurgery, unruptured nidi, and at least 2 years of radiologic follow-up or AVM obliteration were selected for analysis. Statistical analyses were performed to determine actuarial obliteration rates and identify factors associated with obliteration. Results: In the 51 unruptured pediatric AVM patients included for analysis, the median age was 13years, and the most common presentation was seizure in 53%. The median nidus volume and radiosurgical margin dose were 3.2cm3 and 21.5Gy, respectively. The median radiologic follow-up was 45months. The actuarial AVM obliteration rates at 3, 5, and 10years were 29%, 54%, and 72%, respectively. In the multivariate Cox proportional hazards regression analysis, higher margin dose (P = 0.002), fewer draining veins (P = 0.038), and lower Virginia Radiosurgery AVM Scale (P = 0.003) were independent predictors of obliteration. Obliteration rates were significantly higher with a margin dose of at least 22Gy (P = 0.003) and for nidi with 2 or fewer draining veins (P = 0.001). The incidences of radiologically evident, symptomatic, and permanent radiation-induced changes were 55%, 16%, and 2%, respectively. The annual post-radiosurgery hemorrhage rate was 1.3%, and the incidence of post-radiosurgery cyst formation was 2%. Conclusion: Radiosurgery affords a favorable risk to benefit profile for unruptured pediatric AVMs. Pediatric patients with unruptured AVMs merit further study to define an optimal management approach. Springer-Verlag Wien, 2014 Gamma knife nationallicence Intracranial arteriovenous malformation nationallicence Pediatric nationallicence Radiosurgery nationallicence Vascular Malformations nationallicence Ding Dale Department of Neurosurgery, University of Virginia, P.O. Box 800212, 22908, Charlottesville, VA, USA aut Xu Zhiyuan Department of Neurosurgery, University of Virginia, P.O. Box 800212, 22908, Charlottesville, VA, USA aut Yen Chun-Po Department of Neurosurgery, University of Virginia, P.O. Box 800212, 22908, Charlottesville, VA, USA aut Starke Robert Department of Neurosurgery, University of Virginia, P.O. Box 800212, 22908, Charlottesville, VA, USA aut Sheehan Jason Department of Neurosurgery, University of Virginia, P.O. Box 800212, 22908, Charlottesville, VA, USA aut Acta Neurochirurgica Springer Vienna 157/2(2015-02-01), 281-291 0001-6268 157:2<281 2015 157 701 https://doi.org/10.1007/s00701-014-2305-4 text/html Onlinezugriff via DOI BK010053 XK010053 XK010000 Metadata rights reserved Springer special CC-BY-NC licence nationallicence 1 research-article jats NATIONALLICENCE NATIONALLICENCE NL-springer NATIONALLICENCE 856 40 https://doi.org/10.1007/s00701-014-2305-4 text/html Onlinezugriff via DOI NATIONALLICENCE 700 1- Ding Dale Department of Neurosurgery, University of Virginia, P.O. Box 800212, 22908, Charlottesville, VA, USA aut NATIONALLICENCE 700 1- Xu Zhiyuan Department of Neurosurgery, University of Virginia, P.O. Box 800212, 22908, Charlottesville, VA, USA aut NATIONALLICENCE 700 1- Yen Chun-Po Department of Neurosurgery, University of Virginia, P.O. Box 800212, 22908, Charlottesville, VA, USA aut NATIONALLICENCE 700 1- Starke Robert Department of Neurosurgery, University of Virginia, P.O. Box 800212, 22908, Charlottesville, VA, USA aut NATIONALLICENCE 700 1- Sheehan Jason Department of Neurosurgery, University of Virginia, P.O. Box 800212, 22908, Charlottesville, VA, USA aut NATIONALLICENCE 773 0- Acta Neurochirurgica Springer Vienna 157/2(2015-02-01), 281-291 0001-6268 157:2<281 2015 157 701