Citations 2
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.
Woven EndoBridge Device for Ruptured vs. Unruptured Aneurysms: Insights from the WorldWideWEB Study
Dugar, Franja, Essibayi, Muhammed Amir, Adeeb, N, Algin, Oktay, Ghozy, Sherief, Guenego, Adrien, Renieri, Leonardo, Saliou, G, Shotar, Eimad, Möhlenbruch, Markus, Kral, Michael , Chung, Charlotte, Salem, Mohamed M , Cancelliere, Nicole M., Diestro, Jose Danilo Bengzon, Foreman, Paul M. , Shaikh, Hamza, Župančić, Vedran , Waqas, M, Ayberk, Gıyas , Rabinov, James D. , Maingard, Julian , Schirmer, Clemens M., Piano, M, Michelozzi, Caterina , Starke, Robert M., Hassan, A. E., Ogilvie, Mark, Jones, Jesse, Brinjikji, Waleed , Psychogios, Marios, Nawka, Marie Teresa , Fiehler, Jens, Nguyen-Kim, Thi Dan Linh, Pukenas, Bryan , Burkhardt, J. David, Huynh, Thien, Martinez-Gutierrez, Juan Carlos, Sheth, S, Slawski, Diana , Lubicz, Boris , Puri, A, Raz, E, Griessenauer, Christoph J., Asadi, Hamed, Siddiqui, Adnan, Levy, Elad I, Haranhalli, Neil , Altschul, David, Ducruet, Andrew F. , Regenhardt, Robert W., Stapleton, Christopher J. , Kan, Peter , Lylyk, Pedro, Boddu, Srikanth, Knopman, Jared, Tjoumakaris, Stavropoula I., Cuellar-Saenz, Hugo H., Jabbour, Pascal M., Clarençon, Frédéric, Patankar, Tufail , Pereira, Vitor Mendes, Patel, Aman B., Almohammad, Mohammad, Kemmling, Andre, Dmytriw, Adam A., Diestro, Jose Danilo Bengzon , Diestro, Jose Danilo B , Dugar, Franja , Essibayi, Muhammed Amir , Salim, Hamza , Musmar, Basel , Adeeb, Nimer , Dibas, Mahmoud , Li, Yan-Lin, Algin, Oktay , Ghozy, Sherief , Lay, Sovann V. , Guenego, Adrien , Renieri, Leonardo , Carnevale, Joseph, Saliou, Guillaume , Mastorakos, Panagiotis , Shotar, Eimad , Möhlenbruch, Markus , Salem, Mohamed Raafet Ben, Lylyk, Iván , Cancelliere, Nicole M , Hafeez, Muhammad Ubaid , Catapano, Joshua S , Waqas, Muhammad , Ayberk, Gıyas , Arslan, Muhammet , Ergun, Onur, Maingard, Julian, Schirmer, Clemens M. , Piano, Mariangela , Kühn, Anna L., Starke, Robert M., Hassan, Ameer, Ogilvie, Mark , Jones, Jesse , Zaccagna, Fulvio , Grist, James T. , Psychogios, Marios‐Nikos , Fiehler, Jens , Nguyen‐Kim, Thi Dan Linh , Burkhardt, Jan‐Karl , Huynh, Thien , Martinez-Gutierrez, Juan Carlos , Sheth, Sunil A , Tawk, Rabih G. , Pulli, Benjamin , Panni, Pietro , Puri, Ajit S., Pero, Guglielmo , Raz, Eytan , Griessenauer, Christoph J. , Asadi, Hamed , Siddiqui, Adnan H. , Levy, Elad I. , Altschul, David , Regenhardt, Robert W. , Kan, Peter , Kalousek, Vladimir , Lylyk, Pedro, Knopman, Jared , Tjoumakaris, Stavropoula , Cuellar, Hugo , Jabbour, Pascal , Clarençon, Frédéric , Limbucci, Nicola , Patel, Aman B. , Almohammad, Mohammad , Kemmling, André , Scarcia, Luca , Dmytriw, Adam A. , Sporns, Peter Bernhard
No container title available | March 18, 2026 | Volume: No volume available | Issue: No issue available | Pages: No page available
Abstract Purpose Although the Woven EndoBridge (WEB) device is increasingly used for the treatment of wide-neck intracranial aneurysms, including in the acute rupture setting, comparative evidence assessing the impact of rupture status remains limited. This study compared angiographic, safety, and clinical outcomes between ruptured and unruptured intracranial aneurysms treated with WEB. Methods We conducted a retrospective analysis of prospectively collected data from the multicenter cohort registry WorldWideWEB, including consecutive adult patients with intracranial aneurysms treated with the WEB. Patients were stratified into groups of ruptured and unruptured aneurysms. Propensity score matching was used to balance baseline characteristics between both groups. Retreatment rate was the primary outcome. Secondary outcomes included mRS, safety events (thromboembolic complications) and angiographic outcomes (periprocedurally and last follow-up). Results Among 1,220 patients, 342 (28.0%) presented with ruptured aneurysms. There was no significant difference in the rate of thromboembolic complications between groups (11.8% vs 5.9%, p = 0.056). At follow-up, adequate occlusion was lower (82.2% vs 93.3%, p < 0.002) and functional outcomes were worse (mRS ≥2 in 34.1% vs 21.9%, p = 0.012) among patients with ruptured aneurysms. Periprocedural adequate occlusion (53.3% vs 53.8%, p>0.9) and retreatment rates (11.8% vs 7.1%, p = 0.14) did not differ between groups after matching. Conclusion Ruptured aneurysms demonstrated expected inferior follow-up functional and angiographic outcomes when compared with unruptured aneurysms, but no difference in retreatment rate and procedural safety. These findings support WEB as a safe and effective treatment option for appropriately selected ruptured intracranial aneurysms in routine clinical practice.