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Comprehensive Endovascular and Open Surgical Management of Cerebral Arteriovenous Malformations
Published on: October 20, 2017
Long-Term Outcomes After Stereotactic Radiosurgery for Pediatric Brain Arteriovenous Malformations: A Systematic
Samuel D Pettersson1, Mohamed K Elrafie2, Jakub Makarewicz2
1Neurosurgical Service, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA; Department of Neurosurgery, Medical University of Gdansk, Gdansk, Poland.
Insights
Long-term outcomes for pediatric brain arteriovenous malformations (AVMs) treated with stereotactic radiosurgery (SRS) show a 77% obliteration rate by 10 years. However, complication rates like radiation-induced necrosis (8%) warrant cautious interpretation of these findings.
Area of Science:
- Neurology
- Neurosurgery
- Radiation Oncology
Background:
- Long-term outcomes of stereotactic radiosurgery (SRS) for pediatric brain arteriovenous malformations (AVMs) are not well-established.
- A lack of longitudinal studies necessitates a comprehensive review of existing data.
Purpose of the Study:
- To systematically review and pool data on long-term outcomes following SRS for pediatric AVMs.
- To determine cumulative incidences of AVM obliteration and associated complications.
Main Methods:
- A systematic review of PubMed, Embase, and Web of Science databases was performed.
- Studies included pediatric patients (<18 years) with AVMs treated by SRS and a mean follow-up >5 years.
- Individual patient data were used to create a pooled Kaplan-Meier plot for obliteration rates.
Main Results:
- Data from 6 studies involving 1315 pediatric patients with a mean follow-up of 86.6 months were analyzed.
- Cumulative AVM obliteration rates were 48.3% at 3 years, 76.1% at 5 years, and 77.5% at 10 years.
- Cumulative incidences of post-SRS hemorrhage, tumors, cysts, seizures, radiation-induced necrosis, edema, and radiation-induced changes (RICs) were reported.
Conclusions:
- The quality of studies assessing long-term SRS outcomes for pediatric AVMs is moderate and retrospective.
- Complication rates may be underestimated due to follow-up loss, advising cautious interpretation.
- Future prospective studies are recommended to validate these long-term outcome findings.
Background:
The long-term outcomes after stereotactic radiosurgery (SRS) for pediatric brain arteriovenous malformations (AVMs) remain poorly understood given the paucity of longitudinal studies. A systematic review was conducted to pool cumulative incidences for all outcomes.
Methods:
PubMed, Embase, and Web of Science were queried to systematically extract potential references. The articles relating to AVMs treated via SRS were required to be written in English, involve pediatric patients (<18 years of age), and include a mean follow-up period of >5 years. Individual patient data were obtained to construct a pooled Kaplan-Meier plot on obliteration rates over time.
Results:
Among the 6 studies involving 1315 pediatric patients averaging a follow-up period of 86.6 months (range, 6-276), AVM obliteration was observed in 66.1% with cumulative probabilities of 48.28% (95% confidence interval [CI], 41.89-54.68), 76.11% (95% CI, 67.50-84.72), 77.48% (95% CI, 66.37-88.59) over 3, 5, and 10 years, respectively. The cumulative incidence of post-SRS hemorrhage, tumors, cysts, and de novo seizures was 7.2%, 0.3%, 1.6%, and 1.5%, respectively. The cumulative incidence of radiation-induced necrosis, edema, radiologic radiation-induced changes (RICs), symptomatic RICs, and permanent RICs were 8.0%, 1.4%, 28.0%, 8.7%, and 4.9%, respectively.
Conclusions:
Studies assessing long-term outcomes after SRS are moderate in quality and retrospective. Thus, interpretation with caution is advised given the variable degree of loss to follow-up, which suggests that complication rates may be higher than the values stated in the literature. Future prospective studies are needed to validate these findings.
