Neuropediatrics 2006; 37 - PS4_3_5
DOI: 10.1055/s-2006-945802

POST GAMMA KNIFE HA IN CHILDREN AND ADOLESCENTS C/A

S Maimone 1, DA Rothner 1
  • 1Cleveland Clinic Foundation, Cleveland, OH, United States

Objectives: To describe the HA's and MRI changes in C/A following gamma knife surgery (GKS) for AVM's to discuss pathophysiology and treatment.

Methods: 9 C/A were seen for AVM and treated with GKS. We reviewed their charts with attention to HA, clinical presentation, MRI and outcome. The GKS literature of AVM was reviewed.

Results: 5 presented with hemorrhage, 3 with HA, and 1 with seizures. Each had a single AVM. Spetzler-Martin grades were II-V. No pretreatment HA in 2/9, mild HA in 5/9 and migrainous HA in 2/9. Post GKS, HA absent in 3/9 patients, mild in 2/9 patients, and severe in 4/9. Of these 4 patients, 2 had mild pre GKS HA, and 2 had migrainous pre GKS HA. The severe HA's occurred up to 30 months following GKS, 2 immediately, one 6–12 months, and one 1–2 years after GKS. Size and Spetzler-Martin grade did not correlate with HA severity. Treatment with >30gy increased the likelihood of HA compared to <30gy. MRI revealed 3/9 had nidus obliteration. In 6 it was reduced in size. Of the 4 patients with severe HA, 3 had residual nidus. Of 4 patients 3 had MRI white matter intensities with their severe HA.

Conclusion: Post GKS HA in adults occur in 0.3–32% of patients. In an adult patient Rozen noted a correlation between HA and white matter changes. The etiology of the post GKS HA and white matter abnormalities is unknown. They occur in patients with a previous history of HA and in those receiving >30gy. They may be related to change in blood flow as the AVM is obliterated or radiation changes with necrosis or edema. Treatment is symptomatic. For severe HA, IV steroids have been useful. Early recognition and aggressive intervention may decrease morbidity.