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Characterization of pediatric infratentorial arteriovenous malformation response to stereotactic radiosurgery: A retrospective, multicenter cohort study

Friday, May 3, 2024

    Presenting Author(s)

  • Rebecca Calafiore, MD (she/her/hers)

    Neurosurgery Resident
    Wake Forest University School of Medicine
    Winston Salem, NC, US

    • Co-Author(s)

  • Gene H. Barnett, MD, MBA

    Vice-Chairman of Neurosurgery
    Cleveland Clinic
    Cleveland, Ohio, United States

  • AB

    Andrea Becerril-Gaitan, MD

    Research Fellow
    The University of Texas Health Science Center, United States

  • KB

    Katherine Belanger, MD

    Neurosurgery Resident
    Wake Forest University School of Medicine
    Winston Salem, North Carolina, United States

  • Rebecca M. Burke, MD, PhD

    Assistant Professor of Neurosurgery
    Wake Forest University School of Medicine
    Salt Lake City, Utah, United States

  • Ching-Jen Chen, MD

    Assistant Professor of Neurosurgery
    The University of Texas Health Science Center
    Houston, Texas, United States

  • Dale Ding, MD

    Professor
    Department of Neurosurgery, University of Louisville College of Medicine, Louisville, Ky, USA
    Louisville, Kentucky, United States

  • CF

    Caleb Feliciano, MD

    Assistant Professor of Neurosurgery
    University of Puerto Rico
    San Juan, United States

  • IG

    Inga Grills, MD

    Radiation Oncologist
    Beaumont Health System
    Royal Oak, Michigan, United States

  • CI

    Christian Iorio-Morin, MD, PhD

    Assistant Professor of Neurosurgery
    Université de Sherbrooke, Centre de recherche du CHUS
    Sherbrooke, Canada

  • Douglas Kondziolka, MD, MSc

    Neurosurgeon
    NYU Langone Medical Center
    New York, NY, US

  • LL

    L. Dade Lunsford, MD

    Professor of Neurological Surgery
    University of Pittsburgh Medical Center
    Pittsburgh, Pennsylvania, United States

  • DM

    David Mathieu, MD

    Neurosurgeon
    Université de Sherbrooke, Centre de recherche du CHUS
    Sherbrooke, QC, Canada

  • Chesney S. Oravec, MD

    Neurosurgery Resident
    Wake Forest University School of Medicine
    Winston Salem, North Carolina, United States

  • Jason Sheehan, MD, PhD

    Professor of Neurosurgery
    Department of Neurological Surgery, University of Virginia, Charlottesville, Virginia, USA
    Charlottesville, Virginia, United States

  • Robert Starke, MD

    Associate Professor of Neurosurgery
    University of Miami
    Miami Beach, Florida, United States

  • HY

    Huai-Che Yang, MD

    Neurosurgeon
    Taipei Veterans General Hospital, Taipei, Taiwan (Republic of China)

Introduction: Infratentorial arteriovenous malformations (AVMs) harbor different characteristics compared to supratentorial AVMs. This study aims to explore the unique characteristics of pediatric infratentorial AVMs and their response to single session stereotactic radiosurgery (SRS).

Methods: The International Radiosurgery Research Foundation (IRRF) database of pediatric AVM patients (age < 18) who underwent SRS was retrospectively reviewed. Baseline demographics, AVM characteristics, outcomes, and complications post-SRS were compared between infratentorial and supratentorial pediatric AVMs. Unfavorable outcome was defined as the absence of AVM obliteration, post-SRS hemorrhage, or permanent radiation-induced changes (RIC) at last follow up.

Results: A total of 535 pediatric AVMs managed with SRS with a median follow-up of 67 months (IQR 29.0-130.6) were included, with 69 being infratentorial and 466 supratentorial. The infratentorial group had a higher proportion of deep location (58.4% vs 30.3%, P= < 0.001), deep venous drainage (79.8% vs 61.8%, P=0.004), and prior embolization (26.1% vs 15.7%, P=0.032). There was a higher proportion of hemorrhagic presentation in the infratentorial group (79.7% vs 71.3%, P=0.146). There was no statistically significant difference in the odds of an unfavorable outcome (OR=1.36 [0.82-2.28]), AVM obliteration (OR=0.85 [0.5-1.43]), post-SRS hemorrhage (OR=0.83 [0.31-2.18]), or radiological RIC (OR=1.08 [0.63-1.84]) between both cohorts. No statistically significant difference on the rates of outcomes of interest and complications were found in the adjusted model.

Conclusion : Despite baseline differences between infratentorial and supratentorial pediatric AVMs, SRS outcomes, including AVM obliteration and post-SRS hemorrhage rates, were comparable amongst both groups. SRS appears to have a similar risk profile and therapeutic benefit to infratentorial pediatric AVMs as it does for those with a supratentorial location.