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Updated: Apr 19, 2026
Comprehensive Endovascular and Open Surgical Management of Cerebral Arteriovenous Malformations
Published on: October 20, 2017
Stereotactic radiosurgery for pediatric patients with intracranial arteriovenous malformations: variables that may
O O Galván De la Cruz1, P Ballesteros-Zebadúa2, S Moreno-Jiménez1
1Unidad de Radioneurocirugía, Instituto Nacional de Neurología y Neurocirugía, Mexico, Mexico.
Insights
Adult AVM indexes do not predict obliteration in pediatric patients. Treatment technique, location eloquence, and follow-up time influence obliteration rates in pediatric arteriovenous malformations (AVMs) treated with stereotactic radiosurgery (SRS).
Area of Science:
- Neurology
- Pediatric Neurosurgery
- Radiation Oncology
Background:
- Pediatric arteriovenous malformations (AVMs) treatment outcomes are debated.
- Existing AVM classification indexes are derived from adult populations.
- The efficacy of adult-based indexes in predicting pediatric AVM obliteration is uncertain.
Purpose of the Study:
- To analyze factors influencing obliteration time and probability in pediatric AVMs.
- To evaluate the applicability of adult AVM indexes in a pediatric cohort.
- To assess the impact of stereotactic radiosurgery (SRS) variables on pediatric AVM obliteration.
Main Methods:
- Analysis of 45 pediatric patients (<18 years) with AVMs.
- Minimum and maximum follow-up periods of 10 and 112 months, respectively.
- Logistic regression and Kaplan-Meier analysis to assess variables including age, AVM volume, dose, follow-up time, sex, hemorrhage history, venous drainage, treatment technique, prior treatment, and location. Evaluation of Spetzler-Martin, RBAS, and K index predictive power.
Main Results:
- Treatment technique (circular arcs vs. dynamic arcs) showed a potential influence on obliteration (p=0.057).
- Obliteration probability decreased after three years of follow-up (p=0.024).
- Nidus obliteration time correlated with location (Spetzler-Martin index), with non-eloquent regions tending towards shorter obliteration times (p=0.071).
Conclusions:
- Established adult AVM indexes do not reliably predict obliteration in pediatric patients.
- Treatment technique, lesion eloquence, and follow-up duration are key factors influencing pediatric AVM obliteration.
- Alternative treatment strategies should be considered if obliteration is not achieved within three years.
Introduction:
It is debatable whether pediatric patients diagnosed with arteriovenous malformations (AVMs) should be treated as adults. Several indexes to classify AVMs have been proposed in the literature, and most try to predict the outcome for each specific treatment. The indexes differ in the variables considered, but they are all based in adult populations. In this study, we analyzed the variables that influence the obliteration time and probability of occurrence in a Mexican pediatric population diagnosed with an AVM and treated with stereotactic radiosurgery (SRS).
Methods:
We analyzed 45 pediatric patients (<18 years) with a minimum follow-up of 10 months and a maximum of 112 months. We used logistic regression analysis and Kaplan-Meier curves to evaluate the influence of age, AVM volume, prescribed dose, minimum dose, maximum dose, time of follow-up, sex, previous hemorrhage, venous drainage, treatment technique, previous treatment and location. We also evaluated the predictive power of the following indexes: Spetzler-Martin, RBAS, or K index dose deviation.
Results:
We found that the radiation technique used may influence the obliteration occurrence (p=0.057). The data suggests that circular arcs are a more efficient treatment technique than dynamic arcs. However, no relationship of dose or volume with treatment technique could be found. Obliteration was also dependent on follow-up time and after three years of follow-up, the obliteration probability decreases (p=0.024). According to Kaplan-Meier analysis, the nidus obliteration time was related with the location according to the Spetzler-Martin index. If the nidus was located in a non-eloquent region, there was a tendency of a shorter obliteration time (p=0.071).
Conclusion:
None of the previously proposed indexes for adults predict obliteration in this pediatric population. Treatment technique, eloquence and follow up time were the only variables that showed influence in obliteration. Since the highest probability of obliteration occurs during the first three years, if the nidus has not been obliterated after this time then another treatment option could be considered.
