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Stereotactic Radiosurgery in Pediatric Neurovascular Diseases

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Pediatric Vascular Neurosurgery

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Abstract

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.

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Author information

Authors and Affiliations

  1. Department of Neurological Surgery, Columbia University Medical Center, The Neurological Institute, 710 W. 168th Street, New York, 10032, NY, USA

    Hannah E. Goldstein MD

  2. Medical Student, College of Physicians and Surgeons, Columbia University Medical Center, 630 West 168th Street, New York, 10032, NY, USA

    Stephen G. Bowden BM & Sunjay M. Barton BA

  3. Assistant Professor, Radiation Oncology, Columbia University Medical Center, 161 Fort Washington Avenue, New York, 10032, NY, USA

    Eileen Connolly MD, PhD

  4. Associate Professor, Neurological Surgery, Columbia University Medical Center, 710 W. 168th Street, New York, 10032, NY, USA

    Richard C. E. Anderson MD, FACS, FAAP

  5. Associate Professor of Neurological Surgery and Radiology, Clinical Co-Director of Neuroendovascular Services, Department of Neurological Surgery, Columbia University Medical Center, 710 W. 168th Street, New York, 10032, NY, USA

    Sean D. Lavine MD, FAANS

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  1. Hannah E. Goldstein MD
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  2. Stephen G. Bowden BM
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  6. Sean D. Lavine MD, FAANS
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Correspondence to Hannah E. Goldstein MD .

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Editors and Affiliations

  1. Department of Neurosurgery, Methodist Neurological Institute, Houston, Texas, USA

    Abhishek Agrawal

  2. Department of Neurosurgery, Methodist Neurological Institute, Houston, Texas, USA

    Gavin Britz

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Goldstein, H.E., Bowden, S.G., Barton, S.M., Connolly, E., Anderson, R.C.E., Lavine, S.D. (2016). Stereotactic Radiosurgery in Pediatric Neurovascular Diseases. In: Agrawal, A., Britz, G. (eds) Pediatric Vascular Neurosurgery. Springer, Cham. https://doi.org/10.1007/978-3-319-43636-4_20

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  • DOI: https://doi.org/10.1007/978-3-319-43636-4_20

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