Related Experiment Video
Updated: Dec 4, 2025
Comprehensive Endovascular and Open Surgical Management of Cerebral Arteriovenous Malformations
Published on: October 20, 2017
Pediatric Intracranial Arteriovenous Malformation: Long-Term Outcomes with Linear Accelerator (LINAC)-Based
Ethan M Glazener1, Kenneth Lodin1, Michael J Miller1
1Department of Radiation Oncology, Kaiser Permanente, Los Angeles, California.
Insights
Linear accelerator-based radiosurgery (LBRS) is a safe and effective treatment for pediatric intracranial arteriovenous malformations (AVM), showing good long-term outcomes and obliteration rates in a recent study.
Area of Science:
- Neurosurgery
- Radiation Oncology
- Pediatric Neurology
Background:
- Intracranial arteriovenous malformations (AVM) pose significant risks in pediatric patients.
- Effective long-term treatment strategies for pediatric AVM are crucial.
Purpose of the Study:
- To evaluate the long-term outcomes of pediatric patients with intracranial AVM treated with linear accelerator-based radiosurgery (LBRS).
Main Methods:
- Retrospective analysis of 34 pediatric patients (≤18 years) treated with LBRS between 2002 and 2016.
- Median LBRS dose of 16.8 Gy to the 80% isodose line.
- Analysis included patient demographics, AVM characteristics, treatment details, and follow-up outcomes.
Main Results:
- Median follow-up was 98 months.
- Sixty-four point seven percent (22/34) of AVMs achieved obliteration at a median of 37 months.
- No treatment-related deaths occurred; two patients experienced post-treatment intracranial hemorrhage, and three had symptomatic radiation necrosis.
Conclusions:
- LBRS is a safe and effective treatment modality for pediatric intracranial AVM.
- Long-term follow-up confirms the efficacy of LBRS in achieving AVM obliteration in children.
- The study supports LBRS as a viable option for managing pediatric AVMs.
Purpose:
To analyze and report the long-term outcomes of intracranial arteriovenous malformations (AVM) treated with linear accelerator (LINAC)-based radiosurgery (LBRS) in the pediatric population.
Methods And Materials:
A series of 34 pediatric patients (≤18 years old) who were treated between 2002 and 2016 were analyzed. All patients were treated with LBRS in a single fraction, with a median dose of 16.8 Gy to the 80% isodose line. Median age at treatment was 14.4 years (range 5.5-18.9). Median AVM volume was 2.91 mL (range 0.228-27.313). Median modified radiosurgery-based AVM score was 0.83 (range 0.18-2.96). The most common presenting symptom was intracranial hemorrhage (ICH) (n = 22, 64.7%). Nine patients underwent intervention before LBRS, which included prior embolization or resection. Seven lesions were in eloquent locations, defined as basal ganglia, thalamus, or brainstem. Cerebral angiography was done to confirm obliteration.
Results:
Median follow-up time was 98 months (range 36-200 months). Twenty-two of the 34 lesions were obliterated (64.7%) with median time to obliteration of 37 months (range 14-79). No deaths occurred during the follow up period; however, two patients experienced ICH after treatment. Three other patients were treated for symptomatic radiation necrosis.
Conclusions:
Treatment of intracranial AVM with LBRS in the pediatric population is demonstrated to be safe and effective with long-term follow up.
