Results of a Conservative Dose Plan Linear Accelerator-Based Stereotactic Radiosurgery for Pediatric Intracranial Arteriovenous Malformations

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• 作者：Vedantam Rajshekhar¹ ; ^{rajshekhar@cmcvellore.ac.in" class="auth_mail" title="E-mail the corresponding author} ; Ranjith K. Moorthy¹ ; Visalakshi Jeyaseelan² ; Subhashini John³ ; Faith Rangad³ ; P.N. Viswanathan³ ; Paul Ravindran³ ; Rabiraja Singh³
• 关键词：Arteriovenous malformation ; Intracranial ; Linear accelerator ; Stereotactic radiosurgery
• 刊名：World Neurosurgery
• 出版年：2016
• 出版时间：November 2016
• 年：2016
• 卷：95
• 期：Complete
• 页码：425-433
• 全文大小：3170 K

文摘

To evaluate the obliteration rate and clinical outcome following linear accelerator (LINAC)-based stereotactic radiosurgery (SRS) for intracranial arteriovenous malformation (AVM) in pediatric patients (age ≤18 years).

Methods

Factors associated with the obliteration rate and neurologic complications were studied retrospectively in pediatric patients who underwent LINAC-based SRS for AVM between June 1995 and May 2014.

Results

The study cohort comprised 36 males and 33 females, with a median age at the time of SRS of 14 years (range, 7–18 years). The mean AVM volume was 8.5 ± 8.7 cc (range, 0.6–41.8 cc). The median marginal dose of radiation delivered was 15 Gy (range, 9–20 Gy). Magnetic resonance imaging (MRI) demonstrated complete obliteration of the AVM in 44 of the 69 patients (63.8%), at a mean follow up of 27.5 months (range, 12–90 months). On subgroup analysis, 41 of the 53 AVMs of ≤14 cc in volume (77.3%) were obliterated. AVMs with a modified AVM radiosurgery score <1 had significantly shorter obliteration times from the time of SRS (P = .006). On multivariate analysis, the mean marginal dose of radiation delivered to the AVM was the sole significant predictor of obliteration (odds ratio, 1.6; 95% confidence interval, 1 to 2.4).

Conclusions

A modest median marginal dose of 15 Gy (16 Gy in the obliterated AVM group vs. 12 Gy in the nonobliterated group) resulted in an obliteration rate of 66.7% after LINAC-based SRS for intracranial AVM, with low rate.