Introduction: Cerebral AVMs carry significant risk of morbidity and mortality related to intracerebral hemorrhage. The annual rate of hemorrhage ranges from 2% to 4%. Some have suggested that the yearly risk of hemorrhage from AVMs maybe higher in the pediatric population. Many believe that AVM vessels in children have less mature morphology. The fact that AVMs treated in childhood have the capacity in rare instances to reoccur has been touted as evidence of the dynamic character of these lesions in childhood. All these, give rise to the question of whether different characteristics of cAVMs in children/adolescents and adults could lead to different radiosurgical outcomes. In the present study, we are going to expand our experience with treating cAVMs in children/adolescents and adults specifically with focus on differences in posttreatment complications (new neurological deficits, headaches), seizure outcome and adverse radiation effect, functional outcomes (obliteration interval and obliteration rate) and hemorrhage rate after stereotactic radiosurgery (SRS).
Methods: This will be a retrospective comparative study. The cohort was selected for the two age groups 1) patients up to and including 18 years of age at treatment and 2) patients more than 18 years with brain AVMs who treated with SRS from 2003 to 2014 and had been observed for 3 years. The data relevant to this study were collected from the case notes of each patient.
Results: Statistical comparisons between obliteration rate and obliteration interval in children/adolescents and adults will be based on the Fisher exact two-tailed test (OR) and the Wilcoxon rank–sum test (OI). Annual hemorrhage rates are calculated based on years of follow-up and the total number of hemorrhages. We considere p values less than 0.05 to be significant.
Conclusions: The results will reveal whether SRS has similar success rates in pediatric/adolescents and adult patients in the treatment of cAVMs.
Patient Care: The findings will reveal whether stereotactic radiosurgery can be a primary option in the treatment of pediatric/adolescent arteriovenous malformations as adult patients.
Learning Objectives: By the conclusion of this session, participants should be able to: 1)Describe the importance of differences in outcomes and adverse events associated with SRS for cAVMs in pediatric/adolescents and adult patients and the effects of radiation on the developing brain in children compared with adult patients, 2 )Discus, in small groups, how much different pediatric cAVMs behave from those in adults after Gamma Knife surgery and discus the efficacy and safety of SRS for AVMs in children less than 18 years old in comparison with adult patients. This comparative analysis will also assist in achieving better understanding of the claims of higher obliteration rates with SRS in pediatric/adolescent patients in existing literature.