J Neurol (2008) 255:551–560 DOI 10.1007/s00415-008-0739-4 ORIGINAL COMMUNICATION D. R. Buis C. M. F. Dirven F. J. Lagerwaard E. S. Mandl G. J. Lycklama à Nijeholt S. Eshghi R. van den Berg J. C. Baayen O. W. M. Meijer B. J. Slotman W. P. Vandertop Radiosurgery of brain arteriovenous malformations in children JON 2739 Received: 1 March 2007 Received in revised form: 31 July 2007 Accepted: 5 September 2007 Published online: 19 February 2008 D. R. Buis, M.D. () · E. S. Mandl, M.D. · J. C. Baayen, M.D. · W. P. Vandertop, M.D., Ph.D. Dept. of Neurosurgery Neurosurgical Center Amsterdam VU University Medical Center, 2F-005 P. O. Box 7057 1007 MB Amsterdam, The Netherlands Tel.: +31-204443714 Fax: +31-204443784 E-Mail: dr.buis@vumc.nl C. M. F. Dirven, M.D., Ph.D. Dept. of Neurosurgery Erasmus Medical Center Rotterdam, The Netherlands F. J. Lagerwaard, M.D., Ph.D. · O. W. M. Meijer, M.D. · B. J. Slotman, M.D., Ph.D. Dept. of Radiation Oncology VU University Medical Center Amsterdam, The Netherlands G. J. Lycklama à Nijeholt, M.D., Ph.D. Dept. of Radiology Medisch Centrum Haaglanden The Hague, The Netherlands S. Eshghi, M.D. · R. van den Berg, M.D., Ph.D. Dept. of Neuroradiology VU University Medical Center Amsterdam, The Netherlands This manuscript was presented at the 56 th Annual Meeting of the Congress of Neuro- logical Surgeons, Chicago, IL, October 2006. ■ Abstract Objective The authors describe their experience in treat- ing 22 children with a single brain arteriovenous malformation (bAVM) using a dedicated LINAC stereotactic radiosurgery unit. Methods The findings of 22 consec- utive patients ≤ 18 years of age who underwent radiosurgery for a sin- gle bAVM and with at least 24 months of follow-up, or earlier proven obliteration, were reviewed. The median age at radiosurgery was 13.8 years, with a hemorrhagic presentation in 86 %. Median bAVM-volume was 1.8ml, with a median prescribed marginal dose of 19.0 Gy. Results The crude com- plete obliteration-rate was 68 % (n = 15) after a median follow-up of 24 months. The actuarial oblitera- tion-rate was 45 % after two years and 64 % after three years. Patients with a radiosurgery-based AVM score ≤ 1 more frequently had an excellent outcome than patients with a bAVM score > 1 (71% vs. 20 %, P = 0.12), as well as an in- creased obliteration rate (P = 0.03) One patient died from a bAVM-re- lated hemorrhage 27 months after radiosurgery, representing a post- radiosurgery hemorrhage rate of 1.3%/year for the complete follow- up interval. Overall outcome was good to excellent in 68 % (n = 15). Radiation-induced changes on MR imaging were seen in 36 % (n = 8) after a median interval of 12.5 months, resulting in deterioration of pre-existing neurological symp- toms in one patient. Conclusions Radiosurgery is a relatively effec- tive, minimally invasive treatment for small bAVMs in children.The rebleeding rate is low, provided that known predilection places for bleeding had been endovascularly eliminated. Our overall results compare unfavourably to recent pediatric microsurgical series, al- though comparison between series remains imprecise. Nevertheless, when treatment is indicated in a child with a bAVM that is amenable to both microsurgery or radio- surgery, microsurgery should care- fully be advocated over radio- surgery, because of its immediate risk reduction. ■ Key words cerebrovascular disorders · intracranial arteriovenous malformations · pediatrics · radiosurgery · stereotaxic techniques