{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,18]],"date-time":"2026-08-18T01:55:22Z","timestamp":1787018122647,"version":"build-2736575974"},"reference-count":23,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"10","content-domain":{"domain":["www.ahajournals.org"],"crossmark-restriction":true},"short-container-title":["Stroke"],"published-print":{"date-parts":[[2019,10]]},"abstract":"<jats:sec>\n                    <jats:title>Background and Purpose\u2014<\/jats:title>\n                    <jats:p>The effects of prior hemorrhage on stereotactic radiosurgery (SRS) outcomes for pediatric arteriovenous malformations (AVMs) are not well defined. The aim of this multicenter, retrospective cohort study is to compare the SRS outcomes for unruptured versus ruptured pediatric AVMs.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods\u2014<\/jats:title>\n                    <jats:p>The International Radiosurgery Research Foundation pediatric AVM database from 1987 to 2018 was reviewed retrospectively. Favorable outcome was defined as AVM obliteration, no post-SRS hemorrhage, and no permanently symptomatic radiation-induced changes. Associations between prior hemorrhage and outcomes were adjusted for baseline differences, inverse probability weights, and competing risks.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results\u2014<\/jats:title>\n                    <jats:p>\n                      The study cohort comprised 153 unruptured and 386 ruptured AVMs. Favorable outcome was achieved in 48.4% and 60.4% of unruptured and ruptured AVMs, respectively (adjusted odds ratio, 1.353;\n                      <jats:italic>P<\/jats:italic>\n                      =0.190). Cumulative AVM obliteration probabilities were 51.2%, 59.4%, 64.2%, and 70.0% for unruptured and 61.0%, 69.3%, 74.0%, and 79.3% for ruptured AVMs at 4, 6, 8, and 10 years, respectively (subhazard ratio, 1.311;\n                      <jats:italic>P<\/jats:italic>\n                      =0.020). Cumulative post-SRS hemorrhage probabilities were 4.5%, 5.6%, 5.6%, and 9.8% for unruptured and 4.7%, 6.1%, 6.1%, and 10.6% for ruptured AVMs at 4, 6, 8, and 10 years, respectively (subhazard ratio, 1.086;\n                      <jats:italic>P<\/jats:italic>\n                      =0.825). Probabilities of AVM obliteration (adjusted subhazard ratio, 0.968;\n                      <jats:italic>P<\/jats:italic>\n                      =0.850) and post-SRS hemorrhage (adjusted subhazard ratio, 1.663;\n                      <jats:italic>P<\/jats:italic>\n                      =0.251) were comparable between the 2 cohorts after inverse probability weight adjustments. Symptomatic (15.8% versus 8.1%; adjusted odds ratio, 0.400;\n                      <jats:italic>P<\/jats:italic>\n                      =0.008) and permanent (9.2% versus 5.0%; adjusted odds ratio, 0.441;\n                      <jats:italic>P<\/jats:italic>\n                      =0.045) radiation-induced change were more common in unruptured AVMs.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions\u2014<\/jats:title>\n                    <jats:p>The overall outcomes after SRS for unruptured versus ruptured pediatric AVMs are comparable. However, symptomatic and permanent radiation-induced change occur more frequently in pediatric patients with unruptured AVMs.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1161\/strokeaha.119.026211","type":"journal-article","created":{"date-parts":[[2019,8,7]],"date-time":"2019-08-07T05:00:23Z","timestamp":1565154023000},"page":"2745-2751","update-policy":"https:\/\/doi.org\/10.1161\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":21,"title":["Stereotactic Radiosurgery for Unruptured Versus Ruptured Pediatric Brain Arteriovenous Malformations"],"prefix":"10.1161","volume":"50","author":[{"given":"Ching-Jen","family":"Chen","sequence":"first","affiliation":[{"name":"From the Department of Neurological Surgery, University of Virginia Health System, Charlottesville (C.-J.C., K.N.K., N.I., J.P.S.)"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Cheng-Chia","family":"Lee","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Neurological Institute, Taipei Veterans General Hospital, Taiwan (C.-C.L., S.-W.T.)"},{"name":"School of Medicine, National Yang-Ming University, Taipei, Taiwan (C.-C.L.)"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dale","family":"Ding","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, University of Louisville School of Medicine, KY (D.D., A.F., L.D.L.)"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shih-Wei","family":"Tzeng","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Neurological Institute, Taipei Veterans General Hospital, Taiwan (C.-C.L., S.-W.T.)"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kathryn N.","family":"Kearns","sequence":"additional","affiliation":[{"name":"From the Department of Neurological Surgery, University of Virginia Health System, Charlottesville (C.-J.C., K.N.K., N.I., J.P.S.)"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hideyuki","family":"Kano","sequence":"additional","affiliation":[{"name":"Department of Neurological Surgery, University of Pittsburgh, PA (H.K.)"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ahmet","family":"Atik","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Cleveland Clinic Foundation, OH (A.A., K.J., G.B.)"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Natasha","family":"Ironside","sequence":"additional","affiliation":[{"name":"From the Department of Neurological Surgery, University of Virginia Health System, Charlottesville (C.-J.C., K.N.K., N.I., J.P.S.)"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Krishna","family":"Joshi","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Cleveland Clinic Foundation, OH (A.A., K.J., G.B.)"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Paul P.","family":"Huang","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, New York University Langone Medical Center (P.P.H., D.K.)"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Douglas","family":"Kondziolka","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, New York University Langone Medical Center (P.P.H., D.K.)"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"David","family":"Mathieu","sequence":"additional","affiliation":[{"name":"Division of Neurosurgery, Centre de recherch\u00e9 du CHUS, University of Sherbrooke, Quebec, Canada (D.M., C.I.-M.)"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christian","family":"Iorio-Morin","sequence":"additional","affiliation":[{"name":"Division of Neurosurgery, Centre de recherch\u00e9 du CHUS, University of Sherbrooke, Quebec, Canada (D.M., C.I.-M.)"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Inga S.","family":"Grills","sequence":"additional","affiliation":[{"name":"Department of Radiation Oncology, Beaumont Health System, Royal Oak, MI (I.S.G., T.J.Q., Z.S., K.M.)"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Thomas J.","family":"Quinn","sequence":"additional","affiliation":[{"name":"Department of Radiation Oncology, Beaumont Health System, Royal Oak, MI (I.S.G., T.J.Q., Z.S., K.M.)"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zaid","family":"Siddiqui","sequence":"additional","affiliation":[{"name":"Department of Radiation Oncology, Beaumont Health System, Royal Oak, MI (I.S.G., T.J.Q., Z.S., K.M.)"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kim","family":"Marvin","sequence":"additional","affiliation":[{"name":"Department of Radiation Oncology, Beaumont Health System, Royal Oak, MI (I.S.G., T.J.Q., Z.S., K.M.)"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Caleb","family":"Feliciano","sequence":"additional","affiliation":[{"name":"Section of Neurological Surgery, University of Puerto Rico, San Juan (C.F.)"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Andrew","family":"Faramand","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, University of Louisville School of Medicine, KY (D.D., A.F., L.D.L.)"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Robert M.","family":"Starke","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, University of Miami, FL (R.M.S.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gene","family":"Barnett","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Cleveland Clinic Foundation, OH (A.A., K.J., G.B.)"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"L. Dade","family":"Lunsford","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, University of Louisville School of Medicine, KY (D.D., A.F., L.D.L.)"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jason P.","family":"Sheehan","sequence":"additional","affiliation":[{"name":"From the Department of Neurological Surgery, University of Virginia Health System, Charlottesville (C.-J.C., K.N.K., N.I., J.P.S.)"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"name":"on behalf of the International Radiosurgery Research Foundation","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","reference":[{"key":"e_1_3_2_2_2","doi-asserted-by":"publisher","DOI":"10.1016\/S0387-7604(03)00029-9"},{"key":"e_1_3_2_3_2","doi-asserted-by":"publisher","DOI":"10.1227\/01.NEU.0000367555.16733.E1"},{"key":"e_1_3_2_4_2","doi-asserted-by":"publisher","DOI":"10.1159\/000369959"},{"key":"e_1_3_2_5_2","doi-asserted-by":"publisher","DOI":"10.1161\/STROKEAHA.118.022052"},{"key":"e_1_3_2_6_2","doi-asserted-by":"publisher","DOI":"10.3171\/2016.9.PEDS16284"},{"key":"e_1_3_2_7_2","doi-asserted-by":"publisher","DOI":"10.3171\/jns.1986.65.4.0476"},{"key":"e_1_3_2_8_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.ijrobp.2009.12.056"},{"key":"e_1_3_2_9_2","doi-asserted-by":"publisher","DOI":"10.3171\/2013.5.JNS1311"},{"key":"e_1_3_2_10_2","doi-asserted-by":"publisher","DOI":"10.3171\/jns.1992.77.1.0001"},{"key":"e_1_3_2_11_2","doi-asserted-by":"publisher","DOI":"10.1080\/01621459.1999.10474144"},{"key":"e_1_3_2_12_2","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCULATIONAHA.115.017719"},{"key":"e_1_3_2_13_2","doi-asserted-by":"publisher","DOI":"10.3171\/jns.2004.101.1.0018"},{"key":"e_1_3_2_14_2","doi-asserted-by":"publisher","DOI":"10.1097\/00006123-200107000-00019"},{"key":"e_1_3_2_15_2","first-page":"531","article-title":"Spontaneous obliteration of pial arteriovenous malformations: a review of 27 cases.","volume":"22","author":"Patel MC","year":"2001","unstructured":"Patel, MC, Hodgson, TJ, Kemeny, AA, Forster, DM. 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