Radiosurgical treatment of arteriovenous malformations in a retrospective study group of 33 children: the importance of radiobiological scores

Jody Filippo Capitanio, Pietro Panni, Alberto Luigi Gallotti, Carmen Rosaria Gigliotti, Francesco Scomazzoni, Stefania Acerno, Antonella del Vecchio, Pietro Mortini

Research output: Contribution to journalArticle

Abstract

Purpose: Arteriovenous malformations’ (AVMs) obliteration depends on several factors; among the many factors that must be considered to obtain a high rate of obliteration and a low rate of complications, Flickinger-Pollock Score (FPS) seems to have an important role but still have to be validated in the pediatric population while Paddick-Conformity Index (PCI) still has no demonstration of its utility on the outcome and is considered only as a treatment quality marker. Methods: We retrospectively analyzed 33 consecutive children (2–18 years) with an AVM, treated with stereotactic radiosurgery Gamma Knife (SRS-GK) from 2001 to 2014 in our institution. We assess angiographic (DSA) Obliteration Rate (OR) as well FPS and PCI to draw conclusions. Results: DSA-OR was 60.6% with a rate of hemorrhage of 0%. median target volume (TV) was 3.60 cc (mean 4.32 ± 3.63; range 0.15–14.2), median PD was 22 Gy (mean 21.4 ± 2.6; range 16.5–25). Median percentage of coverage was 98% (mean 97 ± 3; range 84–100). The median modified FPS was 0.78 (mean 0.89 ± 0.52; range 0.21–2.1) and highly correlate with OR (p = 0.01). The median PCI was 0.65 (mean 0.65 ± 0.14; range 0.34–0.95) A PCI lower than 0.57 highly correlates with final OR (p = 0.02). Conclusion: SRS-GK was safe and gradually effective in children. A prescription dose-like that used in adult population (i.e. > 18 and between 20 and 25 Gy) is essential to achieve obliteration. A PD of 23 Gy and 22 Gy did impact OR, respectively (p = 0.02) and (p = 0.05). FPS and PCI are valuable scores that seem to correlate with the OR also in the pediatric population although further prospective studies are needed to confirm these observations.

Original languageEnglish
Pages (from-to)301-308
Number of pages8
JournalChild's Nervous System
Volume35
Issue number2
DOIs
Publication statusPublished - Feb 4 2019

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Keywords

  • Children
  • Gamma knife
  • Pediatric brain malformations
  • Pediatric radiosurgery

ASJC Scopus subject areas

  • Pediatrics, Perinatology, and Child Health
  • Clinical Neurology

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