Stereotactic Radiosurgery in Pediatric Neurovascular Diseases

Stereotactic radiosurgery (SRS) is an evolving approach for the treatment of pediatric neurovascular disease. Since its first use in the treatment of an arteriovenous malformation (AVM) in 1970, it has been used safely and effectively in treating adult patients with AVMs, selected cerebral cavernous malformations (CCM), and arteriovenous fistulas (AVF). More recently, several case series have shown expansion to the pediatric population that have yielded promising results, with SRS achieving total obliteration of AVMs in up to 90 % of patients. The benefits of SRS are likely greatest in lesions that are deep-seated or adjacent to eloquent cortex, where the risks of microsurgery are typically greater than the risks of SRS. The validation of risk scores, which have identified smaller AVM volume and younger age as prognosticators of radiosurgical success, has helped guide patient selection and improve outcomes overall. However, concerns of persistent hemorrhage risk during the latency period prior to obliteration, as well as limited knowledge of long-term, radiation-specific complications, continue to limit the usage of SRS for pediatric neurovascular disease.