Explore the cutting-edge advancements in pediatric neurosurgery as we delve into the efficacy of repeat stereotactic radiosurgery for treating stubborn cerebral arteriovenous malformations in young patients.
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Repeat stereotactic radiosurgery for persistent cerebral arteriovenous malformations in pediatric patients.
Garcia et al., J Neurosurg Pediatr 2024
DOI: 10.3171/2023.12.PEDS23465
Study Highlights:
- New Information: This study provides data on the long-term outcomes of pediatric patients undergoing repeat stereotactic radiosurgery (SRS) for arteriovenous malformations (AVMs).
- Importance: It offers insight into the efficacy and safety of repeat SRS in a pediatric population, a topic with previously limited data.
- Contribution to Literature: The study contributes valuable statistics on outcomes and risks associated with repeat SRS, informing treatment decisions for persistent AVMs in children.
Results Summary:
The study included 83 pediatric patients, with a median age of 11 years at initial SRS and 15 at repeat SRS. After 5 years from the second SRS, 50.6% achieved nidus obliteration, and 44.6% had a favorable outcome. The median time to obliteration and hemorrhage was 35.5 and 38.5 months, respectively. The 5-year cumulative probability of a favorable outcome was 44%, and for obliteration, it was 51%. The risk of hemorrhage during the latency period was 8%, while 30.1% had radiation-induced changes (RICs), with only 6% symptomatic. Delayed cyst formation occurred in 7.2% of patients.
The study supports the consideration of repeat SRS in managing pediatric AVMs, with a low incidence of symptomatic RICs and hemorrhage during the latency period. No cases of radiation-induced neoplasia were reported.