Angiographic features help predict outcome after stereotactic radiosurgery for the treatment of pediatric arteriovenous malformations

Sunil A. Sheth, Matthew B. Potts, Penny K. Sneed, William L. Young, Daniel L. Cooke, Nalin Gupta, Steven W. Hetts*

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

18 Scopus citations


Purpose: Arteriovenous malformations (AVMs) are a frequent cause of hemorrhagic stroke in children. Stereotactic radiosurgery (SRS) is an established treatment for these lesions, particularly those that are surgically inaccessible. Because only complete AVM obliteration is believed to protect against the future risk of hemorrhage, identifying lesion characteristics that predict response to therapy is an important objective. The goal of this study is to evaluate the influence of angiographic features of AVMs on the rate of obliteration following treatment with SRS. Methods: This is a retrospective cohort study of pediatric patients (age ≤18 years) treated with Gamma Knife SRS for cerebral AVMs between 2000 and 2012. Detailed angiographic data at the time of initial angiographic evaluation were prospectively recorded by experienced neurointerventional radiologists. The primary outcome was the rate of obliteration on a 3-year follow-up angiogram. Results: We identified 42 pediatric patients treated with SRS for cerebral AVMs. Twenty-seven patients completed 3-year angiographic follow-ups. Complete obliteration was seen in 30 %, partial response in 67 %, and no response in 4 %. Higher SRS dose was associated with complete obliteration. Larger AVM diameter, presence of multiple draining veins, and presence of multiple draining veins reaching a sinus were associated with partial response. In this small cohort, diffuse AVM borders, presence of aneurysm, and pre-SRS embolization were not associated with obliteration. Conclusions: Our study identifies AVMs in the pediatric population with a nidus diameter of <2.5 cm and a solitary draining vein as the most likely to undergo complete obliteration after SRS treatment.

Original languageEnglish (US)
Pages (from-to)241-247
Number of pages7
JournalChild's Nervous System
Issue number2
StatePublished - Feb 2014


  • Cerebral angiography
  • Intracranial arteriovenous malformations
  • Intracranial hemorrhages
  • Pediatrics
  • Stereotactic radiosurgery

ASJC Scopus subject areas

  • Clinical Neurology
  • Pediatrics, Perinatology, and Child Health


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