Stereotactic radiosurgery in the treatment of pediatric cerebral cavernous malformations: a systematic review and meta-analysis of outcomes and safety

Abstract

Cerebral cavernous malformations (CCMs) are clusters of dilated, thin-walled vascular channels that pose significant neurological risks, particularly in pediatric patients. While stereotactic radiosurgery (SRS) has been explored as a non-invasive treatment modality, its safety and efficacy in children remain incompletely defined. We conducted a systematic review and meta-analysis of single-arm proportions after SRS for pediatric CCMs. PubMed and the Cochrane Library were searched; four retrospective cohort studies met inclusion criteria. Random-effects pooled proportions were calculated for key outcomes. Post-SRS seizure proportion (three studies; n = 73) was 0.23 (95% CI, 0.11-0.37; I² = 23.7%; p = 0.27). A lesion-volume decrease was observed in 0.34 (0.18-0.67; I² = 82.1%; p = 0.0037). Post-SRS hemorrhage proportion (four studies) was 0.22 (0.09-0.52; I² = 76.1%; p = 0.0058). Adverse radiation effects (AREs) were uncommon but variably reported. Findings suggest that radiosurgery may provide benefit in selected pediatric CCMs, though small sample sizes and study heterogeneity warrant cautious interpretation.

Keywords: Cavernous malformations; Pediatrics; Radiosurgery.