Outcomes following stereotactic radiosurgery for high-grade brain arteriovenous malformations: a systematic review and meta-analysis.

IF 3.5 2区 医学 Q1 CLINICAL NEUROLOGY
Imran Farhad, Adam Ridzuan-Allen, Saniya Ansari, Marwan Al-Munaer, Benjamin Hall, Basel Taweel, Christina Skourou, David Fitzpatrick, Ahmad M S Ali, Cathal John Hannan, Julian Cahill, Jawad Yousaf, Jason P Sheehan, Mohsen Javadpour
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引用次数: 0

Abstract

Objective: Arteriovenous malformations (AVMs) of the brain are a leading cause of stroke in the young and carry a lifetime risk of intracerebral hemorrhage. The management options for high-grade AVMs are limited. Resection is often associated with high rates of postoperative morbidity, and the results of stereotactic radiosurgery (SRS) for these lesions thus far have been mixed. The aim of this study was to summate the published data on the outcomes of SRS for high-grade AVMs in order to better inform the management of these otherwise untreatable lesions.

Methods: A search of four online databases for literature pertaining to the use of SRS to treat high-grade (Spetzler-Martin grades IV-VI) AVMs was performed. Data pertaining to AVM obliteration, incidence of adverse radiation effects (AREs), and posttreatment hemorrhage were extracted, and a meta-analysis of proportions was performed. The study protocol was prospectively registered with PROSPERO.

Results: Fifteen studies describing the results of SRS treatment of 562 high-grade AVMs were analyzed. The overall rate of AVM obliteration during a median follow-up period of 50 months was 34.2% (95% CI 27.0%-42.1%, I2 = 65.1%). The pooled rate of hemorrhage following SRS treatment was 12.2% (95% CI 7.8%-18.7%, I2 = 25%). For previously ruptured AVMs, the rate of hemorrhage was 12.7% (95% CI 8.5%-18.7%, I2 = 0%) compared with 5.2% (95% CI 1.0%-23.1%, I2 = 0%) for unruptured AVMs. The overall incidence of AREs was 9.3% (95% CI 5.2%-15.9%, I2 = 0%).

Conclusions: SRS for high-grade AVMs is associated with a modest rate of obliteration and is complicated by AREs in 9% of cases. Patients harboring previously ruptured AVMs or lesions with high-risk angioarchitectural features may be more likely to benefit from this treatment.

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来源期刊
Journal of neurosurgery
Journal of neurosurgery 医学-临床神经学
CiteScore
7.20
自引率
7.30%
发文量
1003
审稿时长
1 months
期刊介绍: The Journal of Neurosurgery, Journal of Neurosurgery: Spine, Journal of Neurosurgery: Pediatrics, and Neurosurgical Focus are devoted to the publication of original works relating primarily to neurosurgery, including studies in clinical neurophysiology, organic neurology, ophthalmology, radiology, pathology, and molecular biology. The Editors and Editorial Boards encourage submission of clinical and laboratory studies. Other manuscripts accepted for review include technical notes on instruments or equipment that are innovative or useful to clinicians and researchers in the field of neuroscience; papers describing unusual cases; manuscripts on historical persons or events related to neurosurgery; and in Neurosurgical Focus, occasional reviews. Letters to the Editor commenting on articles recently published in the Journal of Neurosurgery, Journal of Neurosurgery: Spine, and Journal of Neurosurgery: Pediatrics are welcome.
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