Stereotactic Radiosurgery Outcomes in Arteriovenous Malformations: A Pediatric-Adult Comparative Meta-Analysis

Abstract

Stereotactic radiosurgery (SRS) is an established treatment for brain arteriovenous malformations (AVMs), but outcomes between pediatric and adult populations are not well compared. We conducted a systematic review and meta-analysis comparing SRS outcomes for pediatric versus adult AVMs. PubMed was searched for studies reporting SRS outcomes for pediatric or adult AVMs up to January 2024. Primary outcome was obliteration rate, with secondary outcomes including post-SRS hemorrhage, symptomatic radiation-induced changes (RIC), and permanent RIC. Pooled estimates were calculated using random-effects models. Analysis included 22 studies with 3469 patients (1316 pediatric, 2153 adult). Pooled obliteration rate was 63% (95% CI: 56%-70%) overall, with no significant difference between pediatric (61%) and adult (67%) cohorts (p=0.38). Post-SRS hemorrhage rates were similar (5% pediatric, 6% adult, p=0.60). Symptomatic RIC occurred in 9% (95% CI: 6%-13%) overall, with 10% in both cohorts (p=0.91). Permanent RIC rates were 4% in pediatric and 3% in adult cohorts (p=0.43). Cyst formation (0.6%) and radiation-induced tumors (0.2%) were rare. All-cause mortality was significantly lower in the pediatric cohort (2.6% vs 9.8%, p=0.003). Hemorrhagic AVM presentation was inversely correlated with symptomatic RIC across both groups. SRS is a reasonable treatment option for appropriately selected AVM patients in both pediatric and adult populations, offering comparable obliteration rates and adverse event profiles. The lower mortality in pediatric patients underscores the importance of early intervention in this population given their high cumulative lifetime rupture risks.