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Characterization of Pediatric Infratentorial Arteriovenous Malformations: A Retrospective, Multicenter Cohort Study
Rebecca Calafiore1, Rebecca M Burke1, Andrea Becerril-Gaitan2
1Department of Neurosurgery, Wake Forest University School of Medicine, Winston-Salem , North Carolina , USA.
Insights
Stereotactic radiosurgery (SRS) for pediatric arteriovenous malformations (AVMs) shows comparable obliteration and hemorrhage rates between infratentorial and supratentorial AVMs. This indicates SRS is a safe and effective treatment option for both locations in children.
Area of Science:
- Neurosurgery
- Radiation Oncology
- Pediatric Neurology
Background:
- Infratentorial arteriovenous malformations (AVMs) present distinct characteristics compared to supratentorial AVMs.
- Pediatric AVMs require specific treatment considerations due to developmental factors.
Purpose of the Study:
- To investigate the unique features of pediatric infratentorial AVMs.
- To evaluate the efficacy and safety of single-session stereotactic radiosurgery (SRS) for pediatric infratentorial AVMs.
- To compare outcomes of SRS between pediatric infratentorial and supratentorial AVMs.
Main Methods:
- Retrospective review of the International Radiosurgery Research Foundation database.
- Inclusion criteria: pediatric patients (<18 years) with AVMs treated with SRS.
- Comparison of baseline demographics, AVM characteristics, outcomes, and complications between infratentorial and supratentorial AVM groups.
Main Results:
- A total of 535 pediatric AVMs were analyzed (69 infratentorial, 466 supratentorial).
- Infratentorial AVMs showed a higher prevalence of deep location, deep venous drainage, and prior embolization.
- No statistically significant differences were observed in unfavorable outcomes, AVM obliteration rates, post-SRS hemorrhage, or radiation-induced changes between the two groups.
Conclusions:
- Despite differing baseline characteristics, stereotactic radiosurgery (SRS) yields comparable outcomes for pediatric infratentorial and supratentorial AVMs.
- SRS demonstrates a similar risk profile and therapeutic benefit for both infratentorial and supratentorial pediatric AVMs.
- These findings support SRS as a viable treatment for pediatric AVMs regardless of location.
Background And Objectives:
Infratentorial arteriovenous malformations (AVMs) harbor different characteristics compared with supratentorial AVMs. This study aims to explore the unique characteristics of pediatric infratentorial AVMs and their response to single session stereotactic radiosurgery (SRS).
Methods:
The International Radiosurgery Research Foundation database of pediatric patients with AVM (age <18 years) who underwent SRS was retrospectively reviewed. Baseline demographics, AVM characteristics, outcomes, and complications post-SRS were compared between infratentorial and supratentorial pediatric AVMs. Unfavorable outcome was defined as the absence of AVM obliteration, post-SRS hemorrhage, or permanent radiation-induced changes at last follow-up.
Results:
A total of 535 pediatric AVMs managed with SRS with a median follow-up of 67 months (IQR 29.0-130.6) were included, with 69 being infratentorial and 466 supratentorial. The infratentorial group had a higher proportion of deep location (58.4% vs 30.3%, P = <.001), deep venous drainage (79.8% vs 61.8%, P = .004), and prior embolization (26.1% vs 15.7%, P = .032). There was a higher proportion of hemorrhagic presentation in the infratentorial group (79.7% vs 71.3%, P = .146). There was no statistically significant difference in the odds of an unfavorable outcome (odds ratio [OR] = 1.36 [0.82-2.28]), AVM obliteration (OR = 0.85 [0.5-1.43]), post-SRS hemorrhage (OR = 0.83 [0.31-2.18]), or radiologic radiation-induced changes (OR = 1.08 [0.63-1.84]) between both cohorts. No statistically significant difference on the rates of outcomes of interest and complications were found in the adjusted model.
Conclusion:
Despite baseline differences between infratentorial and supratentorial pediatric AVMs, SRS outcomes, including AVM obliteration and post-SRS hemorrhage rates, were comparable amongst both groups. SRS appears to have a similar risk profile and therapeutic benefit to infratentorial pediatric AVMs as it does for those with a supratentorial location.
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