Christopher Lauren, I Wayan Niryana, Tjokorda Gde Bagus Mahadewa
{"title":"栓塞对颅内动静脉畸形（Spetzler-Martin分级III-V）立体定向放射手术结果的影响：一项系统综述和荟萃分析。","authors":"Christopher Lauren, I Wayan Niryana, Tjokorda Gde Bagus Mahadewa","doi":"10.3389/fsurg.2025.1563256","DOIUrl":null,"url":null,"abstract":"<p><strong>Introduction: </strong>Intracranial arteriovenous malformations (AVMs) classified as Spetzler-Martin (SM) grades III-V present significant therapeutic challenges due to their complex angioarchitecture and high risk of morbidity. Stereotactic radiosurgery (SRS) is a minimally invasive modality for nidus obliteration, often combined with embolization to reduce nidus size and address high-risk vascular features. However, the impact of pre-SRS embolization on obliteration rates, post-SRS hemorrhage, and mortality remains controversial. This systematic review and meta-analysis aim to evaluate the effects of embolization on SRS outcomes in high-grade AVMs.</p><p><strong>Methods: </strong>Following PRISMA guidelines, a comprehensive search of PubMed, ScienceDirect, Cochrane, and Google Scholar was conducted. Studies comparing SRS alone versus SRS with embolization in SM grade III-V AVMs were included. Primary outcomes were obliteration rates, post-SRS hemorrhage, and mortality. Data extraction and quality assessment were performed using the Newcastle-Ottawa Scale, and pooled analysis was conducted using Review Manager (RevMan) software.</p><p><strong>Results: </strong>Out of 4,186 identified studies, five high-quality cohort studies met inclusion criteria. Pooled analysis showed that SRS alone resulted in higher obliteration rates than SRS with embolization (OR: 2.06, 95% CI: 0.92-4.65; <i>p</i>=0.08), though not statistically significant. Post-SRS hemorrhage rates were comparable (OR: 3.07, 95% CI: 0.72-13.08; <i>p</i> = 0.13), and mortality rates showed no significant difference (OR: 0.21, 95% CI: 0.01-4.62; <i>p</i> = 0.32).</p><p><strong>Discussion: </strong>Although embolization aids in nidus volume reduction, it may hinder radiosurgical efficacy by altering nidus architecture and introducing shielding effects. SRS alone demonstrated superior obliteration rates with fewer technical concerns. Individualized treatment planning remains essential, balancing embolization benefits against its potential drawbacks. Future studies should explore advancements in embolic agents and imaging techniques to optimize multimodal strategies for high-grade AVMs.</p>","PeriodicalId":12564,"journal":{"name":"Frontiers in Surgery","volume":"12 ","pages":"1563256"},"PeriodicalIF":1.6000,"publicationDate":"2025-04-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12003381/pdf/","citationCount":"0","resultStr":"{\"title\":\"Impact of embolization on stereotactic radiosurgery outcomes for intracranial arteriovenous malformations Spetzler-Martin grades III-V: a systematic review and meta-analysis.\",\"authors\":\"Christopher Lauren, I Wayan Niryana, Tjokorda Gde Bagus Mahadewa\",\"doi\":\"10.3389/fsurg.2025.1563256\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Introduction: </strong>Intracranial arteriovenous malformations (AVMs) classified as Spetzler-Martin (SM) grades III-V present significant therapeutic challenges due to their complex angioarchitecture and high risk of morbidity. Stereotactic radiosurgery (SRS) is a minimally invasive modality for nidus obliteration, often combined with embolization to reduce nidus size and address high-risk vascular features. However, the impact of pre-SRS embolization on obliteration rates, post-SRS hemorrhage, and mortality remains controversial. This systematic review and meta-analysis aim to evaluate the effects of embolization on SRS outcomes in high-grade AVMs.</p><p><strong>Methods: </strong>Following PRISMA guidelines, a comprehensive search of PubMed, ScienceDirect, Cochrane, and Google Scholar was conducted. Studies comparing SRS alone versus SRS with embolization in SM grade III-V AVMs were included. Primary outcomes were obliteration rates, post-SRS hemorrhage, and mortality. Data extraction and quality assessment were performed using the Newcastle-Ottawa Scale, and pooled analysis was conducted using Review Manager (RevMan) software.</p><p><strong>Results: </strong>Out of 4,186 identified studies, five high-quality cohort studies met inclusion criteria. Pooled analysis showed that SRS alone resulted in higher obliteration rates than SRS with embolization (OR: 2.06, 95% CI: 0.92-4.65; <i>p</i>=0.08), though not statistically significant. Post-SRS hemorrhage rates were comparable (OR: 3.07, 95% CI: 0.72-13.08; <i>p</i> = 0.13), and mortality rates showed no significant difference (OR: 0.21, 95% CI: 0.01-4.62; <i>p</i> = 0.32).</p><p><strong>Discussion: </strong>Although embolization aids in nidus volume reduction, it may hinder radiosurgical efficacy by altering nidus architecture and introducing shielding effects. SRS alone demonstrated superior obliteration rates with fewer technical concerns. Individualized treatment planning remains essential, balancing embolization benefits against its potential drawbacks. Future studies should explore advancements in embolic agents and imaging techniques to optimize multimodal strategies for high-grade AVMs.</p>\",\"PeriodicalId\":12564,\"journal\":{\"name\":\"Frontiers in Surgery\",\"volume\":\"12 \",\"pages\":\"1563256\"},\"PeriodicalIF\":1.6000,\"publicationDate\":\"2025-04-03\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12003381/pdf/\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Frontiers in Surgery\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://doi.org/10.3389/fsurg.2025.1563256\",\"RegionNum\":4,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"2025/1/1 0:00:00\",\"PubModel\":\"eCollection\",\"JCR\":\"Q2\",\"JCRName\":\"SURGERY\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Frontiers in Surgery","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.3389/fsurg.2025.1563256","RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"2025/1/1 0:00:00","PubModel":"eCollection","JCR":"Q2","JCRName":"SURGERY","Score":null,"Total":0}
Impact of embolization on stereotactic radiosurgery outcomes for intracranial arteriovenous malformations Spetzler-Martin grades III-V: a systematic review and meta-analysis.
Introduction: Intracranial arteriovenous malformations (AVMs) classified as Spetzler-Martin (SM) grades III-V present significant therapeutic challenges due to their complex angioarchitecture and high risk of morbidity. Stereotactic radiosurgery (SRS) is a minimally invasive modality for nidus obliteration, often combined with embolization to reduce nidus size and address high-risk vascular features. However, the impact of pre-SRS embolization on obliteration rates, post-SRS hemorrhage, and mortality remains controversial. This systematic review and meta-analysis aim to evaluate the effects of embolization on SRS outcomes in high-grade AVMs.
Methods: Following PRISMA guidelines, a comprehensive search of PubMed, ScienceDirect, Cochrane, and Google Scholar was conducted. Studies comparing SRS alone versus SRS with embolization in SM grade III-V AVMs were included. Primary outcomes were obliteration rates, post-SRS hemorrhage, and mortality. Data extraction and quality assessment were performed using the Newcastle-Ottawa Scale, and pooled analysis was conducted using Review Manager (RevMan) software.
Results: Out of 4,186 identified studies, five high-quality cohort studies met inclusion criteria. Pooled analysis showed that SRS alone resulted in higher obliteration rates than SRS with embolization (OR: 2.06, 95% CI: 0.92-4.65; p=0.08), though not statistically significant. Post-SRS hemorrhage rates were comparable (OR: 3.07, 95% CI: 0.72-13.08; p = 0.13), and mortality rates showed no significant difference (OR: 0.21, 95% CI: 0.01-4.62; p = 0.32).
Discussion: Although embolization aids in nidus volume reduction, it may hinder radiosurgical efficacy by altering nidus architecture and introducing shielding effects. SRS alone demonstrated superior obliteration rates with fewer technical concerns. Individualized treatment planning remains essential, balancing embolization benefits against its potential drawbacks. Future studies should explore advancements in embolic agents and imaging techniques to optimize multimodal strategies for high-grade AVMs.
期刊介绍：
Evidence of surgical interventions go back to prehistoric times. Since then, the field of surgery has developed into a complex array of specialties and procedures, particularly with the advent of microsurgery, lasers and minimally invasive techniques. The advanced skills now required from surgeons has led to ever increasing specialization, though these still share important fundamental principles.
Frontiers in Surgery is the umbrella journal representing the publication interests of all surgical specialties. It is divided into several “Specialty Sections” listed below. All these sections have their own Specialty Chief Editor, Editorial Board and homepage, but all articles carry the citation Frontiers in Surgery.
Frontiers in Surgery calls upon medical professionals and scientists from all surgical specialties to publish their experimental and clinical studies in this journal. By assembling all surgical specialties, which nonetheless retain their independence, under the common umbrella of Frontiers in Surgery, a powerful publication venue is created. Since there is often overlap and common ground between the different surgical specialties, assembly of all surgical disciplines into a single journal will foster a collaborative dialogue amongst the surgical community. This means that publications, which are also of interest to other surgical specialties, will reach a wider audience and have greater impact.
The aim of this multidisciplinary journal is to create a discussion and knowledge platform of advances and research findings in surgical practice today to continuously improve clinical management of patients and foster innovation in this field.
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