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Stereotactic radiosurgery for arteriovenous malformations in pediatric patients: an updated systematic review and
Insights
Stereotactic radiosurgery (SRS) effectively treats pediatric intracranial arteriovenous malformations, achieving a 64.7% obliteration rate. Long-term complications are generally low, but further studies are needed for definitive outcomes.
Area of Science:
- Neurosurgery
- Radiation Oncology
- Pediatric Neurology
Background:
- Intracranial arteriovenous malformations (AVMs) are a leading cause of intracranial hemorrhage in children.
- Stereotactic radiosurgery (SRS) is a common treatment modality for pediatric AVMs.
Purpose of the Study:
- To systematically review and meta-analyze treatment outcomes and long-term complications of SRS for pediatric intracranial AVMs.
Main Methods:
- Systematic review and meta-analysis following PRISMA and MOOSE guidelines.
- Literature search of electronic databases up to February 6, 2024.
- Outcome measures included obliteration rate, hemorrhage, radiation-induced changes, cyst formation, and tumorigenesis.
Main Results:
- Pooled complete obliteration rate after single-fraction SRS was 64.7%.
- Pooled post-SRS hemorrhage rate was 6.2%; symptomatic radiation-induced changes occurred in 8.8% of patients.
- Low incidence of radiation-induced necrosis (2.6%), cyst formation (1.3%), and tumors (0.15%) were reported.
Conclusions:
- SRS is an effective treatment for selected pediatric intracranial AVMs.
- Long-term complication rates appear low, but further longitudinal studies are warranted.
Objective:
Intracranial arteriovenous malformations are the most common cause of intracranial hemorrhages in pediatric patients. Stereotactic radiosurgery (SRS) has been used extensively to treat these lesions. The authors conducted a systematic review and meta-analysis to report treatment outcomes and long-term complications.
Methods:
This study follows the PRISMA and MOOSE guidelines, with the search spanning electronic databases up to February 6, 2024. The outcome measures included obliteration rate, hemorrhage in the latency period, symptomatic radiation-induced changes (RICs), cyst formation, and radiation-induced tumorigenesis.
Results:
A total of 1493 patients across 24 studies were included. The pooled complete obliteration after single-fraction SRS was 64.7% (95% CI 58%-69%). The pooled post-SRS hemorrhage rate at the final follow-up was 6.2% (95% CI 5%-8%). The overall incidence rate of RIC was 31.3% (267/854 patients), and the incidence of symptomatic RIC was 8.8% (114/1289 patients). For permanent symptomatic RIC, the pooled incidence was 4.8% (62/1283 patients). At final follow-up, 17 cases of radiation-induced necrosis were documented among 654 patients (2.6%). Similarly, cyst formation was reported in 1.3% of cases (17/1265 patients) and radiation-induced tumors occurred in 0.15% of cases (2/1342 patients).
Conclusions:
SRS can be considered an effective intervention for appropriately selected pediatric patients with arteriovenous malformations. Long-term complication rates appear to be low but additional longitudinal studies are required to better define the long-term outcomes.
