Repeat stereotactic radiosurgery for persistent cerebral arteriovenous malformations in pediatric patients

OBJECTIVE The purpose of this study was to describe the long-term outcomes and associated risks related to repeat stereotactic radiosurgery (SRS) for persistent arteriovenous malformations (AVMs) in pediatric patients.

METHODS Under the auspices of the International Radiosurgery Research Foundation, this retrospective multicenter study analyzed pediatric patients who underwent repeat, single-session SRS between 1987 and 2022. The primary outcome variable was a favorable outcome, defined as nidus obliteration without hemorrhage or neurological deterioration. Secondary outcomes included rates and probabilities of hemorrhage, radiation-induced changes (RICs), and cyst or tumor formation.

RESULTS The cohort included 83 pediatric patients. The median patient age was 11 years at initial SRS and 15 years at repeat SRS. Fifty-seven children (68.7%) were managed exclusively using SRS, and 42 (50.6%) experienced hemorrhage prior to SRS. Median AVM diameter and volume were substantially different between the first (25 mm and 4.5 cm3, respectively) and second (16.5 mm and 1.6 cm3, respectively) SRS, while prescription dose and isodose line remained similar. At the 5-year follow-up evaluation from the second SRS, nidus obliteration was achieved in 42 patients (50.6%), with favorable outcome in 37 (44.6%). The median time to nidus obliteration and hemorrhage was 35.5 and 38.5 months, respectively. The yearly cumulative probability of favorable outcome increased from 2.5% (95% CI 0.5%–7.8%) at 1 year to 44% (95% CI 32%–55%) at 5 years. The probability of achieving obliteration followed a similar pattern and reached 51% (95% CI 38%–62%) at 5 years. The 5-year risk of hemorrhage during the latency period after the second SRS reached 8% (95% CI 3.2%–16%). Radiographically, 25 children (30.1%) had RICs, but only 5 (6%) were symptomatic. Delayed cyst formation occurred in 7.2% of patients, with a median onset of 47 months. No radiation-induced neoplasia was observed.

CONCLUSIONS The study results showed nidus obliteration in most pediatric patients who underwent repeat SRS for persistent AVMs. The risks of symptomatic RICs and latency period hemorrhage were quite low. These findings suggest that repeat radiosurgery should be considered when treating pediatric patients with residual AVM after prior SRS. Further study is needed to define the role of repeat SRS more fully in this population.

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Work Title Repeat stereotactic radiosurgery for persistent cerebral arteriovenous malformations in pediatric patients
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Open Access
Creators
  1. Gracie Garcia
  2. Georgios Mantziaris
  3. Stylianos Pikis
  4. Chloe Dumot
  5. L. Dade Lunsford
  6. Ajay Niranjan
  7. Zhishuo Wei
  8. Priyanka Srinivasan
  9. Lilly W. Tang
  10. Roman Liscak
  11. Jaromir May
  12. Cheng Chia Lee
  13. Huai Che Yang
  14. Selcuk Peker
  15. Yavuz Samanci
  16. Ahmed M. Nabeel
  17. Wael A. Reda
  18. Sameh R. Tawadros
  19. Khaled Abdel Karim
  20. Amr M.N. El-Shehaby
  21. Reem Emad Eldin
  22. Ahmed Hesham Elazzazi
  23. Nuria Martínez Moreno
  24. Roberto Martínez Álvarez
  25. Varun Padmanaban
  26. Francis J. Jareczek
  27. James McInerney
  28. Kevin M. Cockroft
  29. Juan Diego Alzate
  30. Douglas Kondziolka
  31. Manjul Tripathi
  32. Jason P. Sheehan
Keyword
  1. Arteriovenous malformation
  2. Stereotactic radiosurgery
  3. Vascular disorders
License In Copyright (Rights Reserved)
Work Type Article
Publisher
  1. Journal of Neurosurgery: Pediatrics
Publication Date January 26, 2024
Publisher Identifier (DOI)
  1. https://doi.org/10.3171/2023.12.PEDS23465
Deposited March 04, 2025

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  • Created

    March 04, 2025 16:47 by Researcher Metadata Database

  • Added RepeatSRS_pedsAVM.pdf

    March 04, 2025 16:47 by Researcher Metadata Database

  • Added Creator Gracie Garcia

    March 04, 2025 16:47 by Researcher Metadata Database

  • Added Creator Georgios Mantziaris

    March 04, 2025 16:47 by Researcher Metadata Database

  • Added Creator Stylianos Pikis

    March 04, 2025 16:47 by Researcher Metadata Database

  • Added Creator Chloe Dumot

    March 04, 2025 16:47 by Researcher Metadata Database

  • Added Creator L. Dade Lunsford

    March 04, 2025 16:47 by Researcher Metadata Database

  • Added Creator Ajay Niranjan

    March 04, 2025 16:47 by Researcher Metadata Database

  • Added Creator Zhishuo Wei

    March 04, 2025 16:47 by Researcher Metadata Database

  • Added Creator Priyanka Srinivasan

    March 04, 2025 16:47 by Researcher Metadata Database

  • Added Creator Lilly W. Tang

    March 04, 2025 16:47 by Researcher Metadata Database

  • Added Creator Roman Liscak

    March 04, 2025 16:47 by Researcher Metadata Database

  • Added Creator Jaromir May

    March 04, 2025 16:47 by Researcher Metadata Database

  • Added Creator Cheng Chia Lee

    March 04, 2025 16:47 by Researcher Metadata Database

  • Added Creator Huai Che Yang

    March 04, 2025 16:47 by Researcher Metadata Database

  • Added Creator Selcuk Peker

    March 04, 2025 16:47 by Researcher Metadata Database

  • Added Creator Yavuz Samanci

    March 04, 2025 16:47 by Researcher Metadata Database

  • Added Creator Ahmed M. Nabeel

    March 04, 2025 16:47 by Researcher Metadata Database

  • Added Creator Wael A. Reda

    March 04, 2025 16:47 by Researcher Metadata Database

  • Added Creator Sameh R. Tawadros

    March 04, 2025 16:47 by Researcher Metadata Database

  • Added Creator Khaled Abdel Karim

    March 04, 2025 16:47 by Researcher Metadata Database

  • Added Creator Amr M.N. El-Shehaby

    March 04, 2025 16:47 by Researcher Metadata Database

  • Added Creator Reem Emad Eldin

    March 04, 2025 16:47 by Researcher Metadata Database

  • Added Creator Ahmed Hesham Elazzazi

    March 04, 2025 16:47 by Researcher Metadata Database

  • Added Creator Nuria Martínez Moreno

    March 04, 2025 16:47 by Researcher Metadata Database

  • Added Creator Roberto Martínez Álvarez

    March 04, 2025 16:47 by Researcher Metadata Database

  • Added Creator Varun Padmanaban

    March 04, 2025 16:47 by Researcher Metadata Database

  • Added Creator Francis J. Jareczek

    March 04, 2025 16:47 by Researcher Metadata Database

  • Added Creator James McInerney

    March 04, 2025 16:47 by Researcher Metadata Database

  • Added Creator Kevin M. Cockroft

    March 04, 2025 16:47 by Researcher Metadata Database

  • Added Creator Juan Diego Alzate

    March 04, 2025 16:47 by Researcher Metadata Database

  • Added Creator Douglas Kondziolka

    March 04, 2025 16:47 by Researcher Metadata Database

  • Added Creator Manjul Tripathi

    March 04, 2025 16:47 by Researcher Metadata Database

  • Added Creator Jason P. Sheehan

    March 04, 2025 16:47 by Researcher Metadata Database

  • Published

    March 04, 2025 16:47 by Researcher Metadata Database

  • Updated

    March 04, 2025 21:05 by [unknown user]

  • Updated Keyword, Description, Publication Date Show Changes

    March 05, 2025 11:13 by avs5190

    Keyword
    • Arteriovenous malformation, Stereotactic radiosurgery, Vascular disorders
    Description
    • OBJECTIVE The purpose of this study was to describe the long-term outcomes and associated risks related to repeat stereotactic radiosurgery (SRS) for persistent arteriovenous malformations (AVMs) in pediatric patients. METHODS Under the auspices of the International Radiosurgery Research Foundation, this retrospective multicenter study analyzed pediatric patients who underwent repeat, single-session SRS between 1987 and 2022. The primary outcome variable was a favorable outcome, defined as nidus obliteration without hemorrhage or neurological deterioration. Secondary outcomes included rates and probabilities of hemorrhage, radiation-induced changes (RICs), and cyst or tumor formation. RESULTS The cohort included 83 pediatric patients. The median patient age was 11 years at initial SRS and 15 years at repeat SRS. Fifty-seven children (68.7%) were managed exclusively using SRS, and 42 (50.6%) experienced hemorrhage prior to SRS. Median AVM diameter and volume were substantially different between the first (25 mm and 4.5 cm<sup>3</sup>, respectively) and second (16.5 mm and 1.6 cm<sup>3</sup>, respectively) SRS, while prescription dose and isodose line remained similar. At the 5-year follow-up evaluation from the second SRS, nidus obliteration was achieved in 42 patients (50.6%), with favorable outcome in 37 (44.6%). The median time to nidus obliteration and hemorrhage was 35.5 and 38.5 months, respectively. The yearly cumulative probability of favorable outcome increased from 2.5% (95% CI 0.5%–7.8%) at 1 year to 44% (95% CI 32%–55%) at 5 years. The probability of achieving obliteration followed a similar pattern and reached 51% (95% CI 38%–62%) at 5 years. The 5-year risk of hemorrhage during the latency period after the second SRS reached 8% (95% CI 3.2%–16%). Radiographically, 25 children (30.1%) had RICs, but only 5 (6%) were symptomatic. Delayed cyst formation occurred in 7.2% of patients, with a median onset of 47 months. No radiation-induced neoplasia was observed. CONCLUSIONS The study results showed nidus obliteration in most pediatric patients who underwent repeat SRS for persistent AVMs. The risks of symptomatic RICs and latency period hemorrhage were quite low. These findings suggest that repeat radiosurgery should be considered when treating pediatric patients with residual AVM after prior SRS. Further study is needed to define the role of repeat SRS more fully in this population.
    • OBJECTIVE The purpose of this study was to describe the long-term outcomes and associated risks related to repeat stereotactic radiosurgery (SRS) for persistent arteriovenous malformations (AVMs) in pediatric patients.
    • METHODS Under the auspices of the International Radiosurgery Research Foundation, this retrospective multicenter study analyzed pediatric patients who underwent repeat, single-session SRS between 1987 and 2022. The primary outcome variable was a favorable outcome, defined as nidus obliteration without hemorrhage or neurological deterioration. Secondary outcomes included rates and probabilities of hemorrhage, radiation-induced changes (RICs), and cyst or tumor formation.
    • RESULTS The cohort included 83 pediatric patients. The median patient age was 11 years at initial SRS and 15 years at repeat SRS. Fifty-seven children (68.7%) were managed exclusively using SRS, and 42 (50.6%) experienced hemorrhage prior to SRS. Median AVM diameter and volume were substantially different between the first (25 mm and 4.5 cm<sup>3</sup>, respectively) and second (16.5 mm and 1.6 cm<sup>3</sup>, respectively) SRS, while prescription dose and isodose line remained similar. At the 5-year follow-up evaluation from the second SRS, nidus obliteration was achieved in 42 patients (50.6%), with favorable outcome in 37 (44.6%). The median time to nidus obliteration and hemorrhage was 35.5 and 38.5 months, respectively. The yearly cumulative probability of favorable outcome increased from 2.5% (95% CI 0.5%–7.8%) at 1 year to 44% (95% CI 32%–55%) at 5 years. The probability of achieving obliteration followed a similar pattern and reached 51% (95% CI 38%–62%) at 5 years. The 5-year risk of hemorrhage during the latency period after the second SRS reached 8% (95% CI 3.2%–16%). Radiographically, 25 children (30.1%) had RICs, but only 5 (6%) were symptomatic. Delayed cyst formation occurred in 7.2% of patients, with a median onset of 47 months. No radiation-induced neoplasia was observed.
    • CONCLUSIONS The study results showed nidus obliteration in most pediatric patients who underwent repeat SRS for persistent AVMs. The risks of symptomatic RICs and latency period hemorrhage were quite low. These findings suggest that repeat radiosurgery should be considered when treating pediatric patients with residual AVM after prior SRS. Further study is needed to define the role of repeat SRS more fully in this population.
    Publication Date
    • 2024-04-01
    • 2024-01-26