Onyx plus stereotactic radiosurgery versus stereotactic radiosurgery alone in patients with cerebral arteriovenous malformations: A systematic review and meta-analysis

IF 1.8 4区医学 Q3 CLINICAL NEUROLOGY

Journal of Clinical Neuroscience Pub Date : 2025-10-02 DOI:10.1016/j.jocn.2025.111653

Luiz Guilherme Silva Almeida , Ocílio Ribeiro Gonçalves , Lucca Tamara Alves Carretta , Mariana Lee Han , Yasmin Picanço Silva , Marcelo Costa , Paweł Łajczak , Julia Sader Neves Ferreira , Gustavo Sousa Noleto

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引用次数: 0

Abstract

Introduction

Stereotactic radiosurgery (SRS) is a primary treatment for cerebral arteriovenous malformations (AVMs). Onyx embolization is used before SRS to reduce AVM size, but its impact remains uncertain. This meta-analysis compares the efficacy and safety of Onyx + SRS versus SRS alone.

Methods

A systematic search of PubMed, Cochrane Library, Scopus, Web of Science, and Embase, adhering to Cochrane guidelines, was conducted to identify studies comparing AVM obliteration rates following Onyx + SRS versus SRS. Data were pooled using a random-effects, inverse-variance model, with I² assessing heterogeneity, and sensitivity analyses performed in R.

Results

SRS alone had higher AVM obliteration rates (OR: 0.63, 95 % CI: 0.41–0.96, p = 0.030). No significant differences were found in post-SRS hemorrhage (OR: 1.37, 95 % CI: 0.63–3.01, p = 0.430), cyst formation (OR: 2.11, 95 % CI: 0.27–16.62, p = 0.477), or mortality (OR: 1.75, 95 % CI: 0.36–8.63, p = 0.490). The overall rate of post-SRS complications was 31.55 % (95 % CI: 23.36–39.75).

Conclusion

This meta-analysis indicates that SRS alone achieves higher AVM obliteration rates than combined Onyx embolization and SRS, without reducing hemorrhage risk or improving safety. Therefore, routine Onyx embolization prior to SRS is not supported by current evidence, suggesting a need for selective application and further investigation to identify optimal treatment strategies.

Takeaway message:

This meta-analysis found that SRS alone achieved a higher AVM obliteration rate compared to combined Onyx embolization plus SRS, with a pooled OR of 0.63 (95 % CI: 0.41–0.96; p = 0.030). No significant differences were observed between groups in post-SRS hemorrhage rates (OR: 1.37, 95 % CI: 0.63–3.01; p = 0.430), cyst formation (OR: 2.11, 95 % CI: 0.27–16.62; p = 0.477), or mortality (OR: 1.75, 95 % CI: 0.36–8.63; p = 0.490). The overall rate of post-SRS complications was 31.55 % (95 % CI: 23.36–39.75).These findings suggest that routine Onyx embolization prior to SRS does not improve efficacy or safety and should be reserved for selected cases.

查看原文本刊更多论文

脑动静脉畸形患者的玛瑙加立体定向放射治疗与单独立体定向放射治疗：系统回顾和荟萃分析

立体定向放射外科（SRS）是脑动静脉畸形（AVMs）的主要治疗方法。在SRS之前使用玛瑙栓塞来减小AVM的大小，但其影响仍不确定。本荟萃分析比较了Onyx + SRS与单独SRS的疗效和安全性。方法根据Cochrane指南，系统检索PubMed、Cochrane Library、Scopus、Web of Science和Embase，比较Onyx + SRS与SRS后AVM湮没率的研究。使用随机效应、反方差模型对数据进行汇总，其中I2评估异质性，并对r进行敏感性分析。结果单独使用ssrs具有更高的AVM湮没率（OR: 0.63, 95% CI: 0.41-0.96, p = 0.030）。srs后出血（OR: 1.37, 95% CI: 0.63-3.01, p = 0.430）、囊肿形成（OR: 2.11, 95% CI: 0.27-16.62, p = 0.477）或死亡率（OR: 1.75, 95% CI: 0.36-8.63, p = 0.490）无显著差异。srs术后并发症总发生率为31.55% （95% CI: 23.36-39.75）。结论本荟萃分析表明，单用SRS栓塞术能达到更高的AVM闭塞率，但不能降低出血风险或提高安全性。因此，目前的证据并不支持在SRS之前进行常规的Onyx栓塞，这表明需要选择性应用并进一步研究以确定最佳治疗策略。结论：该荟萃分析发现，与联合Onyx栓塞+ SRS相比，单独SRS实现了更高的AVM闭塞率，合并OR为0.63 （95% CI: 0.41-0.96; p = 0.030）。srs后出血发生率（OR: 1.37, 95% CI: 0.63-3.01; p = 0.430）、囊肿形成（OR: 2.11, 95% CI: 0.27-16.62; p = 0.477）或死亡率（OR: 1.75, 95% CI: 0.36-8.63; p = 0.490）组间无显著差异。srs术后并发症总发生率为31.55% （95% CI: 23.36-39.75）。这些发现表明，在SRS之前常规的玛窦栓塞不能提高疗效或安全性，应保留用于选定的病例。

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来源期刊

Journal of Clinical Neuroscience 医学-临床神经学

CiteScore

4.50

自引率

0.00%

发文量

402

审稿时长

40 days

期刊介绍： This International journal, Journal of Clinical Neuroscience, publishes articles on clinical neurosurgery and neurology and the related neurosciences such as neuro-pathology, neuro-radiology, neuro-ophthalmology and neuro-physiology. The journal has a broad International perspective, and emphasises the advances occurring in Asia, the Pacific Rim region, Europe and North America. The Journal acts as a focus for publication of major clinical and laboratory research, as well as publishing solicited manuscripts on specific subjects from experts, case reports and other information of interest to clinicians working in the clinical neurosciences.