Citations 1
Efficacy and safety profile of volume-staged stereotactic radiosurgery for ruptured, large pediatric arteriovenous malformations: a multicenter cohort analysis
Tos, Salem M., Hajikarimloo, Bardia, Chan, Jason W., Sneed, Penny K. , McDermott, Michael W. , Seymour, Zachary , Grills, Inga, Reda, Wael A., Tawadros, Sameh R., Eldin, Reem Emad, Lunsford, L Dade, Niranjan, Ajay, Samanci, Yavuz, Lee, Cheng-chia, Yang, Huai-che, Sheehan, Darrah, Sheehan, Kimball, Liscak, Roman, Chytka, Tomáš , Alzate, Juan, Kondziolka, Douglas, Moreno, Nuria Martínez , Martínez‐Álvarez, Roberto , Hallan, David R , Fritch, Chanju, Jareczek, Francis, Sciscent, Bao Y., Mathieu, D, Carrier, Louis, Abdelsalam, Ahmed, Starke, Robert M., BENJAMIN, CAROLINA, Almeida, Timoteo, Singh, S.P., Lazo, Erwin, Chen, Ching-Jen, Esquenazi, Y., Becerril-Gaitan, Andrea, Blanco, Angel I., Palmer, Joshua D., Picozzi, Piero, Lanterna, Luigi Alberto Andrea, Bowden, Greg N., Peterson, Jennifer L., Chiang, Veronica , Pikis, Stylianos , Xu, Zhiyuan, Sheehan, Jason P., Shinya, Yuki , Tos, Salem M , Hajikarimloo, Bardia , Mantziaris, Georgios , Chan, Jason , Nabeel, Ahmed M. , Reda, Wael A. , Tawadros, Sameh R. , Abdelkarim, Khaled , El-Shehaby, Amr M. N. , Eldin, Reem M. Emad, Bin-Alamer, Othman , Lunsford, L. Dade , Niranjan, Ajay , Peker, Selçuk , Samancı, Yavuz , Lee, Cheng-chia, Yang, Huai‐Che , Sheehan, Darrah, Sheehan, Kimball , Liščák, Roman , Alzate, Juan Diego , Meng, Ying , Martinez-Álvarez, Roberto, Fritch, Chanju , Jareczek, Francis J. , Sciscent, Bao Y. , Mathieu, David , Abdelsalam, Ahmed , Starke, Robert M., Almeida, Timóteo , Tripathi, Manjul , Speckter, Herwin , Lazo, Erwin , Esquenazi, Yoshua , Becerril‐Gaitan, Andrea , Amsbaugh, Mark J. , Upadhyay, Rituraj , Palmer, Joshua D. , Franzini, Andrea , Picozzi, Piero , Lanterna, Andrea Luigi, Bowden, Greg , Sheehan, Jason P.
Journal of Neurosurgery: Pediatrics | June 10, 2026 | Volume: No volume available | Issue: No issue available | Pages: 1-10
OBJECTIVE Ruptured, large pediatric arteriovenous malformations (AVMs) pose a significant management challenge due to high rerupture risk and the morbidity of conventional treatments. Volume-staged stereotactic radiosurgery (VS-SRS) has emerged as an alternative; however, evidence for its use in this specific population is limited. This study aimed to evaluate the long-term efficacy and safety of VS-SRS for ruptured, large AVMs in a dedicated pediatric cohort. METHODS This international, multicenter, retrospective cohort study from 21 centers analyzed outcomes for 42 pediatric patients (age < 18 years) with previously ruptured, large AVMs treated with VS-SRS. The primary outcome was complete AVM obliteration, and secondary outcomes included post-SRS hemorrhage, radiation-induced changes (RICs), and favorable outcome. Favorable outcome in this study was defined as obliteration without post-SRS hemorrhage or permanent RIC. RESULTS At the initial SRS, the median patient age was 14.5 years, and the median AVM volume was 15.0 cm 3 ; most AVMs were high grade (Spetzler-Martin grades IV and V). With a median follow-up of 41.5 months, complete AVM obliteration was achieved in 21 patients (50.0%). The cumulative obliteration rate was 37% at 5 years and 56% at 10 years. Patients with a nidus volume of ≤ 10 cm 3 had significantly higher cumulative obliteration rates than those with a nidus volume > 10 cm 3 (log-rank test, p = 0.021). Similarly, patients treated with a prescription dose > 17 Gy showed significantly higher cumulative obliteration rates compared to those treated with a dose ≤ 17 Gy (log-rank test, p = 0.012). The cumulative 5-year incidences of hemorrhage and RICs following VS-SRS were 19% and 7%, respectively. In multivariable analysis, only larger total AVM volume was an independent predictor of a lower likelihood of favorable outcome (hazard ratio 0.89, 95% CI 0.80–0.99; p = 0.036). CONCLUSIONS In this multicenter pediatric cohort, VS-SRS for ruptured, large AVMs provides a reasonable chance of long-term obliteration, but generally acceptable risks of post-SRS hemorrhage and RICs exist. VS-SRS should be considered as an option for pediatric patients with large, ruptured AVMs.