Repeat stereotactic radiosurgery for persistent cerebral arteriovenous malformations in pediatric patients

Result code in IS VaVaI

<a href="https://www.isvavai.cz/riv?ss=detail&h=RIV%2F00023884%3A_____%2F24%3A00009922" target="_blank" >RIV/00023884:_____/24:00009922 - isvavai.cz</a>

Result on the web

<a href="https://thejns.org/pediatrics/view/journals/j-neurosurg-pediatr/33/4/article-p307.xml" target="_blank" >https://thejns.org/pediatrics/view/journals/j-neurosurg-pediatr/33/4/article-p307.xml</a>

DOI - Digital Object Identifier

<a href="http://dx.doi.org/10.3171/2023.12.PEDS23465" target="_blank" >10.3171/2023.12.PEDS23465</a>

Result language

angličtina

Original language name

Repeat stereotactic radiosurgery for persistent cerebral arteriovenous malformations in pediatric patients

Original language description

OBJECTIVE The purpose of this study was to describe the long-term outcomes and associated risks related to repeat stereotactic radiosurgery (SRS) for persistent arteriovenous malformations (AVMs) in pediatric patients. METHODS Under the auspices of the International Radiosurgery Research Foundation, this retrospective multicenter study analyzed pediatric patients who underwent repeat, single -session SRS between 1987 and 2022. The primary outcome variable was a favorable outcome, defined as nidus obliteration without hemorrhage or neurological deteriora - tion. Secondary outcomes included rates and probabilities of hemorrhage, radiation -induced changes (RICs), and cyst or tumor formation. RESULTS The cohort included 83 pediatric patients. The median patient age was 11 years at initial SRS and 15 years at repeat SRS. Fifty-seven children (68.7%) were managed exclusively using SRS, and 42 (50.6%) experienced hemorrhage prior to SRS. Median AVM diameter and volume were substantially different between the first (25 mm and 4.5 cm 3 , respectively) and second (16.5 mm and 1.6 cm 3 , respectively) SRS, while prescription dose and isodose line remained similar. At the 5 -year follow-up evaluation from the second SRS, nidus obliteration was achieved in 42 patients (50.6%), with favorable outcome in 37 (44.6%). The median time to nidus obliteration and hemorrhage was 35.5 and 38.5 months, respectively. The yearly cumulative probability of favorable outcome increased from 2.5% (95% CI 0.5%-7.8%) at 1 year to 44% (95% CI 32%-55%) at 5 years. The probability of achieving obliteration followed a similar pattern and reached 51% (95% CI 38%-62%) at 5 years. The 5 -year risk of hemorrhage during the latency period after the second SRS reached 8% (95% CI 3.2%-16%). Radiographically, 25 children (30.1%) had RICs, but only 5 (6%) were symptomatic. Delayed cyst formation occurred in 7.2% of patients, with a median onset of 47 months. No radiation -induced neoplasia was observed. CONCLUSIONS The study results showed nidus obliteration in most pediatric patients who underwent repeat SRS for persistent AVMs. The risks of symptomatic RICs and latency period hemorrhage were quite low. These findings suggest that repeat radiosurgery should be considered when treating pediatric patients with residual AVM after prior SRS. Further study is needed to define the role of repeat SRS more fully in this population.

Czech name

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Czech description

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Type

J_imp - Article in a specialist periodical, which is included in the Web of Science database

CEP classification

—

OECD FORD branch

30103 - Neurosciences (including psychophysiology)

Project

—

Continuities

N - Vyzkumna aktivita podporovana z neverejnych zdroju

Publication year

2024

Confidentiality

S - Úplné a pravdivé údaje o projektu nepodléhají ochraně podle zvláštních právních předpisů

Name of the periodical

Journal of Neurosurgery: Pediatrics

ISSN

1933-0707

e-ISSN

—

Volume of the periodical

33

Issue of the periodical within the volume

4

Country of publishing house

US - UNITED STATES

Number of pages

8

Pages from-to

307-314

UT code for WoS article

001220974100002

EID of the result in the Scopus database

2-s2.0-85189695636