gms | German Medical Science

62nd Annual Meeting of the German Society of Neurosurgery (DGNC)
Joint Meeting with the Polish Society of Neurosurgeons (PNCH)

German Society of Neurosurgery (DGNC)

7 - 11 May 2011, Hamburg

10 years of experience: treatment of pediatric arteriovenous malformations by Gamma Knife radiosurgery

Meeting Abstract

  • K. Pistracher - Universitätsklinik für Neurochirurgie, Medizinische Universität Graz, Graz, Österreich
  • S. Kurschel - Universitätsklinik für Neurochirurgie, Medizinische Universität Graz, Graz, Österreich
  • B. Schmid - Universitätsklinik für Neurochirurgie, Medizinische Universität Graz, Graz, Österreich
  • K. Dominikus - Universitätsklinik für Strahlentherapie-Radioonkologie, Medizinische Universität Graz, Graz, Österreich
  • F. Unger - Universitätsklinik für Neurochirurgie, Medizinische Universität Graz, Graz, Österreich

Deutsche Gesellschaft für Neurochirurgie. Polnische Gesellschaft für Neurochirurgen. 62. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC), Joint Meeting mit der Polnischen Gesellschaft für Neurochirurgen (PNCH). Hamburg, 07.-11.05.2011. Düsseldorf: German Medical Science GMS Publishing House; 2011. DocP 003

doi: 10.3205/11dgnc224, urn:nbn:de:0183-11dgnc2248

Published: April 28, 2011

© 2011 Pistracher et al.
This is an Open Access article distributed under the terms of the Creative Commons Attribution License ( You are free: to Share – to copy, distribute and transmit the work, provided the original author and source are credited.



Objective: We evaluated the 10-year follow-up of pediatric intracerebral arteriovenous malformations (AVMs) treated with Gamma Knife radiosurgery (GKRS).

Methods: GKRS was performed on 34 children suffering from intracerebral AVM. 12 children were treated by a single radiosurgical procedure and 4 by repeated GKRS. In 18 children GKRS was performed as secondary therapy after operation and/or embolization. The median lesion diameter was 17.3 mm (range 6 to 33 mm) treated by a median dose of 21 Gy (range 12.5 to 28 Gy). The median margin isodose was the 50% isodose (range 40% to 90%).

Results: Median follow-up of the 23 children was 79 months (range 24 to 162 months). In 16 cases complete obliteration was proven by angiography, in one case by MR-angiography after 3.5 years. In 6 patients only partial obliteration was seen. In the recent literature a 75% obliteration rate 3 years after GKRS has been reported. According to our experience a marginal dose of 20 Gy on the 50% isodose is most effective. In our series AVMs of a volume smaller than 3 cm3 showed better and faster obliteration than those exceeding this size. In 2 cases radiosurgery-related complications occurred after GKRS without any permanent neurological deficit. In the literature a risk of 2–3% is mentioned for radiation effects with permanent neurological deficit. Hemorrhage was noted in one child 10 months after GKRS (4% incidence in recent literature).

Conclusions: GKRS is a safe and effective technique in the treatment of pediatric AVMs. Especially those graded as Spezler-Martin grade 3 (small volume, deeply located) seem to be most suitable for GKRS. In larger AVMs treatment with additional embolization, operation or staged radiosurgical procedure is recommended.