Leksell gamma knife radiosurgery for cerebral arteriovenous malformations in pediatric patients
The Verona neurosurgical group provides us with a very important contribution regarding the results of GK surgery in pediatric arteriovenous malformations (AVM). Based on one of the largest studies on AVM radiosurgery in pediatric patients, they report a high rate of success and a very limited number of side effects. More importantly, the factors influencing the outcome have been analyzed. The volume of the nidus turns out to be, as previously reported, a major determinant. Most of the time, multimodality treatment is useful in difficult cases. We agree with the authors that new bleeding is more frequent in children. Thus, in small AVMs in functional areas, short-term complete obliteration with angiographic control must be the goal. We agree with the authors that when the goal can be reached with radiosurgery alone, previous attempts at endovascular reduction are not beneficial. We must congratulate the authors on this remarkably clear and well-presented work. This commentary refers to the article http:// dx.doi.org/10.1007/s00381-004-1049-5