AI Article Synopsis

  • - The systematic review and meta-analysis investigated the safety and effectiveness of repeated stereotactic radiosurgery for treating brain arteriovenous malformations (AVMs), particularly when initial surgery does not completely eliminate the AVM.
  • - Results showed a 60.82% rate of obliteration of the AVMs after repeat radiosurgery, with smaller AVM volumes and lower Spetzler-Martin grades leading to better outcomes, while the average time to obliteration was about 33 months.
  • - Complications from repeat surgeries included radiation-induced changes (10.33%) and post-radiosurgery hemorrhage (5.26%), but overall, the repeat procedure was deemed safe and effective for selected patients with an acceptable risk-to

Article Abstract

Background: Stereotactic radiosurgery is the preferred option for treating brain arteriovenous malformation (AVM) when the risks associated with surgery outweigh the potential benefits. However, some patients require repeat radiosurgery due to residual AVM after the first procedure. This systematic review and meta-analysis aimed to investigate the safety and efficacy of repeated procedure of radiosurgery for AVM.

Method: A systematic review was conducted according to the PRISMA guideline. The search was conducted on PubMed, Scopus, Embase, and Web of Science, using a pre-designed search string. Studies investigating the efficacy of repeat radiosurgery for residual AVM following initial single session radiosurgery were included. The risk of bias was assessed using the JBI tool. Meta-analysis and met-regression were performed to pool and inspect data.

Results: Our meta-analysis, with a mean follow-up of 45.57 months, reveals repeat radiosurgery as a viable option for arteriovenous malformations (AVMs), achieving a 60.82% obliteration rate with a mean time to obliteration of 33.18 months. Meta-regression identifies AVM volume and Spetzler-Martin (SM) grade as factors influencing obliteration, with smaller volume and lower SM grades associated with higher rates. Complications include 10.33% radiation-induced changes, 5.26% post-radiosurgery hemorrhage, 2.56% neurologic deficits, and 0.67% cyst formation. Heterogeneity in complications is primarily attributed to male proportion and SM grade, while factors influencing post-radiosurgery hemorrhage remain unclear. The type of radiosurgery, whether Gamma Knife Radiosurgery (GKRS) or LINAC, does not significantly impact outcomes.

Conclusion: Repeat radiosurgery is a feasible, effective, and safe treatment for AVMs following failure of initial radiosurgery. When utilized in appropriate patient subgroups, it provides an acceptable risk-to-benefit profile. Feature studies are required to clarify its clear indications.

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Source
http://dx.doi.org/10.1007/s10143-024-02438-5DOI Listing

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