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01-12-2024 | Arteriovenous Malformation | Research

Repeat single-session stereotactic radiosurgery for arteriovenous malformation: a systematic review and meta-analysis

Authors: Seyed Farzad Maroufi, Mohammad Amin Habibi, Mohammad Sina Mirjani, Ayoob Molla, Nafise Pabarja, Mahdi Mehmandoost, Jason P. Sheehan, Arad Iranmehr

Published in: Neurosurgical Review | Issue 1/2024

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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Title: Repeat single-session stereotactic radiosurgery for arteriovenous malformation: a systematic review and meta-analysis
Authors: Seyed Farzad Maroufi
Mohammad Amin Habibi
Mohammad Sina Mirjani
Ayoob Molla
Nafise Pabarja
Mahdi Mehmandoost
Jason P. Sheehan
Arad Iranmehr
Publication date: 01-12-2024
Publisher: Springer Berlin Heidelberg
Keyword: Arteriovenous Malformation
Published in: Neurosurgical Review / Issue 1/2024
Print ISSN: 0344-5607
Electronic ISSN: 1437-2320
DOI: https://doi.org/10.1007/s10143-024-02438-5

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Repeat single-session stereotactic radiosurgery for arteriovenous malformation: a systematic review and meta-analysis

Abstract

Background

Method

Results

Conclusion

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Background

Method

Results

Conclusion

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