Citations 1
Volume-Staged Stereotactic Radiosurgery in Pediatric Patients With Large Brain Arteriovenous Malformations: An International, Multicenter Study
Hajikarimloo, Bardia , Tos, Salem M., Ferguson, Robert , Chan, Jason W., Sneed, Penny K. , McDermott, Michael W., Seymour, Zachary , Grills, Inga, Reda, Wael A., Tawadros, Sameh R., Abdelkarim, Khaled, Emad, Reem M. , Lunsford, L. Dade, Niranjan, Ajay, Peker, S A, Samanci, Yavuz, Lee, Cheng-chia, Yang, Huai-che, Sheehan, Darrah, Sheehan, Kimball, Liscak, Roman, Chytka, Tomáš , Alzate, Juan, Kondziolka, Douglas, Moreno, Nuria Martínez , Álvarez, Roberto Martínez , Hallan, David R , Fritch, Chanju, Jareczek, Francis J., Sciscent, Bao Y., Mathieu, David, Carrier, Louis, Abdelsalam, Ahmed, Starke, Robert M., BENJAMIN, CAROLINA, Almeida, Timoteo, Singh, S.P., Lazo, Erwin, Chen, C Y, Esquenazi, Yoshua, 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 , Sheehan, Jason P. , Sheehan, Jason , Tos, Salem M , Mantziaris, Georgios , Shinya, Yuki , Chan, Jason , McDermott, Michael W. , Nabeel, Ahmed M. , Reda, Wael A. , Tawadros, Sameh R. , El-Shehaby, Amr M. N. , 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 , Kondziolka, Douglas, Meng, Ying , 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 , Warnick, Ronald E.
Neurosurgery | June 16, 2026 | Volume: No volume available | Issue: No issue available | Pages: No page available
BACKGROUND AND OBJECTIVES: Pediatric large-volume brain arteriovenous malformations (AVMs) carry a substantial lifelong hemorrhage risk, neurological symptoms, and treatment morbidity. Single-session stereotactic radiosurgery (SRS) is often unsuitable due to constraints on dose-volume toxicity. Volume-staged SRS (VS-SRS) enables sequential dosing of large nidus volumes, potentially enhancing safety while maintaining efficacy. Evidence in children remains limited. We aimed to evaluate outcomes of VS-SRS for large AVMs in pediatric patients. METHODS: A multicenter retrospective cohort was assembled from 21 centers, including patients aged younger than 21 years treated with VS-SRS for AVMs >10 cm 3 . Clinical and radiological end points included obliteration, hemorrhage, and permanent symptomatic radiation-induced changes (RIC). RESULTS: A total of 103 patients were included (median age 14 years; IQR, 12-17). The median nidus volume at first stage was 18.2 cm 3 (IQR, 12.3-25.6). Median prescription dose per stage was 17 Gy (IQR, 16-18). The median clinical follow-up from the first stage was 57.5 months (IQR, 25-138). Obliteration occurred in 42 of 103 patients (40.8%), with actuarial rates of 6.9% (95% CI: 2.8-14) at 3 years and 29% (95% CI: 20-39) at 5 years. Hemorrhage occurred in 17 of 103 patients (16.5%) during follow-up, and permanent RIC was observed in 9 of 103 patients (8.7%). CONCLUSION: VS-SRS is a reasonably safe, selected option for pediatric large-volume AVMs when microsurgical or endovascular cure is not feasible or prudent. Delivering ≥17 Gy per stage while limiting each treatment volume to <15 cm 3 supports durable nidus control with acceptable toxicity. VS-SRS represents a key modality in multidisciplinary management of this historically difficult-to-treat population.