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Updated: Jun 16, 2025
Comprehensive Endovascular and Open Surgical Management of Cerebral Arteriovenous Malformations
Published on: October 20, 2017
Stereotactic Radiosurgery Outcomes in Arteriovenous Malformations: A Pediatric-Adult Comparative Meta-Analysis
Muhammed Amir Essibayi1, Salem M Tos2, Taylor Vadset3
1Department of Neurological Surgery and Montefiore-Einstein Cerebrovascular Research Lab, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York, USA.
Insights
Stereotactic radiosurgery (SRS) offers comparable obliteration rates and adverse events for pediatric and adult brain arteriovenous malformations (AVMs). Pediatric patients experienced significantly lower mortality, suggesting early intervention benefits for AVMs.
Area of Science:
- Neurology
- Neurosurgery
- Radiation Oncology
Background:
- Stereotactic radiosurgery (SRS) is a key treatment for brain arteriovenous malformations (AVMs).
- Comparative outcome data between pediatric and adult AVM patients undergoing SRS is limited.
- This study addresses the need for direct comparison of SRS efficacy and safety in these distinct age groups.
Purpose of the Study:
- To systematically review and meta-analyze outcomes of SRS for pediatric versus adult brain AVMs.
- To compare obliteration rates, hemorrhage risk, and radiation-induced changes between pediatric and adult cohorts.
- To evaluate the safety and efficacy of SRS across different age groups for AVM treatment.
Main Methods:
- A systematic literature search of PubMed was conducted for studies reporting SRS outcomes in pediatric or adult AVMs up to January 2024.
- Primary outcome was the obliteration rate; secondary outcomes included post-SRS hemorrhage and symptomatic/permanent radiation-induced changes (RICs).
- Pooled estimates were calculated using random-effects models to compare outcomes between pediatric and adult populations.
Main Results:
- The analysis included 22 studies with 3469 patients (1316 pediatric, 2153 adult).
- Overall obliteration rate was 63%, with no significant difference between pediatric (61%) and adult (67%) cohorts (P=0.38).
- Post-SRS hemorrhage (5% vs. 6%), symptomatic RICs (10% vs. 10%), and permanent RICs (4% vs. 3%) were similar. Pediatric patients had significantly lower all-cause mortality (2.6% vs. 9.8%, P=0.003).
Conclusions:
- Stereotactic radiosurgery is a viable treatment for selected pediatric and adult AVM patients, yielding similar obliteration rates and safety profiles.
- The lower mortality observed in pediatric patients highlights the potential benefit of early intervention, considering their elevated lifetime rupture risk.
- SRS demonstrates comparable efficacy and safety for brain AVM treatment across pediatric and adult populations, with a notable survival advantage for younger patients.
Background:
Stereotactic radiosurgery (SRS) is an established treatment for brain arteriovenous malformations (AVMs), but outcomes between pediatric and adult populations are not well compared. We conducted a systematic review and meta-analysis comparing SRS outcomes for pediatric versus adult AVMs.
Methods:
PubMed was searched for studies reporting SRS outcomes for pediatric or adult AVMs up to January 2024. Primary outcome was obliteration rate, with secondary outcomes including post-SRS hemorrhage, symptomatic radiation-induced changes (RICs), and permanent RICs. Pooled estimates were calculated using random effects models.
Results:
Analysis included 22 studies with 3469 patients (1316 pediatric, 2153 adult). Pooled obliteration rate was 63% (95% confidence interval: 56%-70%) overall, with no significant difference between pediatric (61%) and adult (67%) cohorts (P = 0.38). Post-SRS hemorrhage rates were similar (5% pediatric, 6% adult, P = 0.60). Symptomatic RICs occurred in 9% (95% confidence interval: 6%-13%) overall, with 10% in both cohorts (P = 0.91). Permanent RIC rates were 4% in pediatric and 3% in adult cohorts (P = 0.43). Cyst formation (0.6%) and radiation-induced tumors (0.2%) were rare. All-cause mortality was significantly lower in the pediatric cohort (2.6% vs. 9.8%, P = 0.003). Hemorrhagic AVM presentation was inversely correlated with symptomatic RICs across both groups.
Conclusions:
SRS is a reasonable treatment option for appropriately selected AVM patients in both pediatric and adult populations, offering comparable obliteration rates and adverse event profiles. The lower mortality in pediatric patients underscores the importance of early intervention in this population given their high cumulative lifetime rupture risks.
