| Title: |
Repeat stereotactic radiosurgery for persistent cerebral arteriovenous malformations in pediatric patients |
| Authors: |
Garcia, Gracie; Mantziaris, Georgios; Pikis, Stylianos; Dumot, Chloe; Lunsford, L. Dade; Niranjan, Ajay; Wei, Zhishuo; Srinivasan, Priyanka; Tang, Lilly; Liscak, Roman; May, Jaromir; Lee, Cheng-Chia; Yang, Huai-Che; Peker, Selcuk; Samanci, Yavuz; Nabeel, Ahmed; Reda, Wael; Tawadros, Sameh; Abdel Karim, Khaled; El-Shehaby, Amr; Emad Eldin, Reem; Elazzazi, Ahmed Hesham; Martínez Moreno, Nuria; Martínez Álvarez, Roberto; Padmanaban, Varun; Jareczek, Francis; Mcinerney, James; Cockroft, Kevin; Alzate, Juan Diego; Kondziolka, Douglas; Tripathi, Manjul; Sheehan, Jason |
| Contributors: |
University of Virginia; Cardiovasculaire, métabolisme, diabétologie et nutrition (CarMeN); Université Claude Bernard Lyon 1 (UCBL); Université de Lyon-Université de Lyon-Hospices Civils de Lyon (HCL)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Institut National de Recherche pour l’Agriculture, l’Alimentation et l’Environnement (INRAE); University of Pittsburgh Medical Center Pittsburgh, PA, États-Unis (UPMC); Nemocnice Na Homolce Hospital; Taipei Veterans General Hospital Taiwan; National Yang Ming Chiao Tung University Taipei (NYCU); Koc University School of Medicine Istanbul, Turkey (KUSOM); Benha University (BU); Nasser Institute Hospital Cairo, Egypt; جامعة عين شمس - Ain Shams University Cairo (ASU); Cairo University; Hospital Ruber Internacional Madrid, Spain (HRI); Penn State Health Milton S. Hershey Medical Center; Pennsylvania Commonwealth System of Higher Education (PCSHE)-Penn State System; NYU Langone Health New York; Postgraduate Institute of Medical Education and Research Chandigarh, India (PIMER) |
| Source: |
ISSN: 1933-0715. |
| Publisher Information: |
CCSD; American Association of Neurological Surgeons, 2004- |
| Publication Year: |
2024 |
| Collection: |
HAL Lyon 1 (University Claude Bernard Lyon 1) |
| Subject Terms: |
arteriovenous malformation; stereotactic radiosurgery; vascular disorders; [SDV]Life Sciences [q-bio] |
| Description: |
International audience ; 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 deterioration. 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 ... |
| Document Type: |
article in journal/newspaper |
| Language: |
English |
| Relation: |
info:eu-repo/semantics/altIdentifier/pmid/38277659; PUBMED: 38277659 |
| DOI: |
10.3171/2023.12.PEDS23465 |
| Availability: |
https://inserm.hal.science/inserm-04668839; https://doi.org/10.3171/2023.12.PEDS23465 |
| Accession Number: |
edsbas.E0CD2398 |
| Database: |
BASE |