Predictors for long-term incomplete nidus obliteration following stereotactic radiosurgery for brain arteriovenous malformations: a systematic review and meta-analysis.
Maurycy Rakowski, Natalia A Koc, Samuel D Pettersson, Tomasz Klepinowski, Piotr Zieliński, Tomasz Szmuda
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引用次数: 0
Abstract
Introduction: This study aimed to identify predictive factors for long-term incomplete nidus obliteration following stereotactic radiosurgery (SRS) for brain arteriovenous malformations (AVMs).
Material and methods: A systematic search across the PubMed, Web of Science, and Scopus databases identified observational studies reporting such factors. Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines were followed. The study protocol was registered through PROSPERO. Each eligible study's quality was assessed using the modified Newcastle-Ottawa Scale. Odds ratios (ORs) were calculated for dichotomous parameters.
Results: Two high-quality prospective cohort and three high-quality retrospective cohort studies were included, covering patients with complete (n = 638) and incomplete (n = 297) nidus obliteration. The mean age of the patients was 25.54 ± 12.81 years and the mean follow-up time was 95.98 ± 27.64 months. Predictors for incomplete obliteration of nidus included: AVM classified as Spetzler-Martin (SM) grade ≥ IV (odds ratio (OR) 10.57, 95% confidence interval (CI) 2.00-55.96, p = 0.006), the presence of multiple (> 1) feeding arteries (OR 6.47, 95% CI 2.20-19.10, p = 0.0007), nidus volume > 10 mL (OR 5.08, 95% CI 1.68-15.33, p = 0.004), and the occurrence of intranidal aneurysm (OR 3.33, 95% CI 1.10-10.08, p = 0.03). No statistically significant difference in proportions of patients with incomplete nidus obliteration was found between paediatric (≤ 18 years) and adult (> 18) patient cohorts (p = 0.95).
Conclusions: The following factors were found to be predictive for long-term incomplete nidus obliteration post-SRS for brain AVMs: SM grade equal to or higher than IV; the presence of multiple feeding arteries; AVM nidus volume exceeding 10 mL; and the occurrence of intranidal aneurysm. These findings will be beneficial in refining patient selection for radiosurgical treatment.
本研究旨在确定立体定向放射手术（SRS）治疗脑动静脉畸形（AVMs）后长期不完全病灶闭塞的预测因素。材料和方法：在PubMed， Web of Science和Scopus数据库中进行系统搜索，确定了报告这些因素的观察性研究。遵循系统评价和荟萃分析（PRISMA）指南的首选报告项目。研究方案通过PROSPERO注册。每个符合条件的研究的质量采用改良的纽卡斯尔-渥太华量表进行评估。计算二分类参数的比值比（ORs）。结果：纳入2项高质量前瞻性队列研究和3项高质量回顾性队列研究，涵盖了完全（n = 638）和不完全（n = 297）病灶闭塞患者。患者平均年龄25.54±12.81岁，平均随访时间95.98±27.64个月。病灶不完全闭塞的预测因素包括：AVM分类为Spetzler-Martin （SM）分级≥IV级（优势比（OR） 10.57, 95%可信区间（CI） 2.00-55.96, p = 0.006），存在多条（>）供血动脉（OR 6.47, 95% CI 2.20-19.10, p = 0.0007），病灶体积> 10ml (OR 5.08, 95% CI 1.68-15.33, p = 0.004)，以及膜内动脉瘤的发生（OR 3.33, 95% CI 1.10-10.08, p = 0.03）。在儿童（≤18岁）和成人（≤18岁）患者队列中，不完全病灶闭塞患者的比例无统计学差异（p = 0.95）。结论：以下因素可预测脑AVMs术后长期不完全病灶闭塞：SM分级≥IV级；有多条供血动脉；AVM病灶体积超过10ml；以及膜内动脉瘤的发生。这些发现将有助于改进放射外科治疗的患者选择。
期刊介绍：
Polish Journal of Neurology and Neurosurgery is an official journal of the Polish Society of Neurology and the Polish Society of Neurosurgeons, aimed at publishing high quality articles within the field of clinical neurology and neurosurgery, as well as related subspecialties. For more than a century, the journal has been providing its authors and readers with the opportunity to report, discuss, and share the issues important for every-day practice and research advances in the fields related to neurology and neurosurgery.
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