{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,2]],"date-time":"2026-06-02T07:56:57Z","timestamp":1780387017431,"version":"3.54.1"},"reference-count":90,"publisher":"Journal of Neurosurgery Publishing Group (JNSPG)","issue":"1","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2025,7,1]]},"abstract":"<jats:sec>\n                    <jats:title>OBJECTIVE<\/jats:title>\n                    <jats:p>Pediatric intracranial arteriovenous malformations (AVMs) have a greater cumulative lifetime risk of rupture than those in adults. Although obliteration after radiation occurs in a dose-dependent manner, increasing radiation doses must be balanced against the risk of adverse radiation effects (AREs). The authors aimed to assess the efficacy of robotic radiosurgery for pediatric AVMs.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>METHODS<\/jats:title>\n                    <jats:p>The authors performed a retrospective review of pediatric patients with AVMs at a single institution who underwent robotic radiosurgery between 2005 and 2021 with one of 3 radiosurgery dosing schedules: 1) single-stage unfractionated (SSU), 2) single-stage fractionated (SSF), and 3) volumetrically multistaged (VMS) treatment. Cox proportional hazards regression was performed to identify predictors of AREs and obliteration.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>RESULTS<\/jats:title>\n                    <jats:p>\n                      Ninety-five patients with 100 intracranial AVMs were identified. Median (range) follow-up time was 4.5 (1.8\u201315.2) years. Forty-four (46.3%) presented with ruptured AVMs. The mean \u00b1 SD AVM volume was 10.0 \u00b1 11.88 cm\n                      <jats:sup>3<\/jats:sup>\n                      . A plurality of AVMs were Spetzler-Martin grade III (36.2%). The overall rate of total obliteration was 52.6% (78.8% of SSU-treated, 24.2% of SSF-treated, 10% of VMS-treated patients) with a median (range) obliteration time of 3.25 (2.8\u20134.1) years. Partial obliteration was achieved in 23.2% of patients. In the univariate analysis, the higher obliteration rate was associated with small volume (HR 0.876, 95% CI 0.812\u20130.945) (p = 0.001), no prior embolization (HR 0.472, 95% CI 0.254\u20130.876) (p = 0.017), lower Spetzler-Martin grade (HR 0.437, 95% CI 0.320\u20130.597) (p \u2264 0.001), and higher single-fraction equivalent dose (HR 1.160, 95% CI 1.020\u20131.198) (p = 0.015). Pretreatment hemorrhage was found in 51 patients (59.6% of SSU-treated, 45.5% of SSF-treated, and 50% of VMS-treated patients). Thirteen patients experienced posttreatment hemorrhage (3.8% of SSU-treated, 12% of SSF-treated, and 60% of VMS-treated patients). AREs were found afterward in 31.6% of patients. The correlations of male sex (HR 0.447, 95% CI 0.199\u20131.004) (p = 0.051) and volume of brain tissue that received a single-fraction equivalent dose of 12 Gy or greater (HR 1.020, 95% CI 1.000\u20131.041) (p = 0.053) with AREs did not reach significance.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>CONCLUSIONS<\/jats:title>\n                    <jats:p>SSU treatment was effective for treating smaller AVMs with an obliteration rate of 79%. Although SSF treatment was less effective in achieving total obliteration (24%), this approach significantly reduced the posttreatment hemorrhage rate by nearly 75% (46% of patients had pretreatment hemorrhage vs 12% with posttreatment hemorrhage). Unfortunately, only 10% of AVMs in the VMS cohort were obliterated and posttreatment hemorrhage rates were not reduced.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3171\/2024.12.peds24211","type":"journal-article","created":{"date-parts":[[2025,4,25]],"date-time":"2025-04-25T22:48:16Z","timestamp":1745621296000},"page":"96-108","source":"Crossref","is-referenced-by-count":3,"title":["Robotic radiosurgery for the treatment of pediatric arteriovenous malformations"],"prefix":"10.3171","volume":"36","author":[{"given":"Lily H.","family":"Kim","sequence":"first","affiliation":[{"name":"Division of Pediatric Neurosurgery, Lucile Packard Children\u2019s Hospital, Stanford, California;"},{"name":"Department of Neurosurgery, Stanford University School of Medicine, Stanford, California;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Teeradon","family":"Treechairusame","sequence":"additional","affiliation":[{"name":"Department of Radiation Oncology, Stanford University School of Medicine, Stanford, California;"},{"name":"Division of Radiation Oncology, Department of Radiology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jennifer","family":"Chiang","sequence":"additional","affiliation":[{"name":"Department of Radiation Oncology, Stanford University School of Medicine, Stanford, California;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zachary","family":"White","sequence":"additional","affiliation":[{"name":"Department of Radiation Oncology, Stanford University School of Medicine, Stanford, California;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Scott","family":"Jackson","sequence":"additional","affiliation":[{"name":"Department of Radiation Oncology, Stanford University School of Medicine, Stanford, California;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jennifer L.","family":"Quon","sequence":"additional","affiliation":[{"name":"Division of Paediatric Neurosurgery, The Hospital for Sick Children, Toronto, Ontario, Canada;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Geoffrey","family":"Appelboom","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, NYU Grossman School of Medicine, New York, New York;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Steven D.","family":"Chang","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Stanford University School of Medicine, Stanford, California;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Scott G.","family":"Soltys","sequence":"additional","affiliation":[{"name":"Department of Radiation Oncology, Stanford University School of Medicine, Stanford, California;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Raphael","family":"Guzman","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, University Hospital of Basel, Switzerland;"},{"name":"Department of Biomedicine, University Hospital of Basel, Switzerland;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Samuel","family":"Cheshier","sequence":"additional","affiliation":[{"name":"Division of Pediatric Neurosurgery, Department of Neurosurgery, University of Utah School of Medicine, Salt Lake City, Utah;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Robert L.","family":"Dodd","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Stanford University School of Medicine, Stanford, California;"},{"name":"Department of Radiology, Stanford University School of Medicine, Stanford, California;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gerald A.","family":"Grant","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Duke University School of Medicine, Durham, North Carolina; and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michael S. B.","family":"Edwards","sequence":"additional","affiliation":[{"name":"Department of Neurological Surgery, UC Davis Medical Center, Sacramento, California"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Iris C.","family":"Gibbs","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Stanford University School of Medicine, Stanford, California;"},{"name":"Department of Radiation Oncology, Stanford University School of Medicine, Stanford, California;"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1754","reference":[{"issue":"12","key":"b1","series-title":"Childs Nerv Syst","first-page":"2137","article-title":"Clinical outcomes and radiosurgical considerations for pediatric arteriovenous malformation: influence of clinical features on obliteration rate","volume":"33","author":"Park CK","year":"2017","unstructured":"Park CK, Choi SK, Lee SH, Choi MK, Lim YJ. 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