Advances in the Multimodal Management of Pediatric Arteriovenous Malformations: A 10-Year Review.

Pediatric brain arteriovenous malformations (AVMs) are rare but high-risk vascular anomalies associated with substantial morbidity and mortality due to their elevated lifetime risk of rupture. Over the past decade, advances in microsurgical resection, stereotactic radiosurgery (SRS), and endovascular embolization have reshaped the management landscape, yet treatment remains highly individualized and controversial, especially in unruptured cases. This narrative review synthesizes findings from 20 eligible studies published between 2015 and 2025, examining outcomes across different modalities. Microsurgical resection demonstrated the highest immediate obliteration rates (>95%) in low-grade, accessible, ruptured lesions, but recurrence rates remain disproportionately higher in children (up to 29%). SRS achieved obliteration rates of 63-72% in Spetzler-Martin (SM) I-III lesions with low complication and recurrence rates, although outcomes were less favorable for higher-grade AVMs. Embolization alone provided limited curative potential but served as an important adjunct in multimodal therapy. Importantly, embolization prior to radiosurgery was associated with reduced obliteration rates and higher complication risks. Across modalities, hemorrhagic presentation often predicted better treatment response, while recurrence and long-term surveillance emerged as central challenges in pediatric care. These findings highlight the necessity of multidisciplinary, individualized management strategies and emphasize the importance of lifelong follow-up to mitigate recurrence risk and optimize outcomes.