OS6.3 Radiosurgery for vascular and tumoral brain lesions in children

Abstract

PURPOSE: The objective of the present study is to assess the long-term safety and efficiency of Gamma Knife radiosurgical treatment of brain arteriovenous malformations and tumors in children. METHOD(S): We reviewed the outcome of a series of 55 children (aged 2.4-15.5 years) who underwent radiosurgical irradiation for a tumoral or vascular brain lesion in our center. This included 21 arteriovenous malformations, 1 cavernoma, 8 pilocytic astrocytoma, 4 grade II glioma, 1 glioblastoma, 3 ependymoma, 3 hypothalamic hamartoma, 8 schwannoma, 2 meningioma, 2 choroid plexus carcinoma, 1 craniopharyngioma, and 1 hemangiopericytoma. All patients had single-session radiosurgery using Gamma Knife C or Perfexion, under general anesthesia for 39 patients. Pathologies with a mean size of 2.8 cc (range 0.1-13.6 cc) were irradiated with a mean margin dose of 16.8 Gy (range 10-25 Gy). RESULT(S): The follow-up period of 45 of these patients ranged from 0.5 to 12 years (mean 4.6 years). The obliteration rate of arteriovenous malformations was 86.6%. No bleeding occurred after radiosurgery. The morbidity was limited to 2 children: 1 patient with AVM had seizures after irradiation and 1 patient with vestibular schwannoma from NF2 lost hearing unilaterally. We observed excellent tumor control for patients with pilocytic astrocytomas, grade II glioma, schwannoma and meningioma, hemangiopericytoma. None of our children with glioblastoma, ependymoma, hypothalamic hamartoma or craniopharyngioma had their tumor controlled in the long term after radiosurgery.