Stereotactic radiosurgery alone or combined with embolization for brain arteriovenous malformations: A systematic review and meta-analysis

Dylan Russell, Travis Peck, Dale Ding, Ching Jen Chen, Davis G. Taylor, Robert M. Starke, Cheng Chia Lee, Jason P. Sheehan

Research output: Contribution to journalArticlepeer-review

34 Scopus citations

Abstract

OBJECTIVE Embolization of brain arteriovenous malformations (AVMs) prior to stereotactic radiosurgery (SRS) has been reported to negatively affect obliteration rates. The goal of this systematic review and meta-analysis was to compare the outcomes of AVMs treated with embolization plus SRS (E+SRS group) and those of AVMs treated with SRS alone (SRS group). METHODS A literature review was performed using PubMed to identify studies with 10 or more AVM patients and obliteration data for both E+SRS and SRS groups. A meta-analysis was performed to compare obliteration rates between the E+SRS and SRS groups. RESULTS Twelve articles comprising 1716 patients were eligible for analysis. Among the patients with radiological follow-up data, complete obliteration was achieved in 48.4% of patients (330/681) in the E+SRS group compared with 62.7% of patients (613/978) in the SRS group. A meta-analysis of the pooled data revealed that the obliteration rate was significantly lower in the E+SRS group (OR 0.51, 95% CI 0.41-0.64, p < 0.00001). Symptomatic adverse radiation effects were observed in 6.6% (27/412 patients) and 11.1% (48/433 patients) of the E+SRS and SRS groups, respectively. The annual post-SRS hemorrhage rate was 2.0%-6.5% and 0%-2.0% for the E+SRS and SRS groups, respectively. The rates of permanent morbidity were 0%-6.7% and 0%-13.5% for the E+SRS and SRS groups, respectively. CONCLUSIONS Arteriovenous malformation treatment with combined embolization and SRS is associated with lower obliteration rates than those with SRS treatment alone. However, this comparison does not fully account for differences in the initial AVM characteristics in the E+SRS group as compared with those in the SRS group. Further studies are warranted to address these limitations.

Original languageEnglish (US)
Pages (from-to)1338-1348
Number of pages11
JournalJournal of neurosurgery
Volume128
Issue number5
DOIs
StatePublished - May 2018

Keywords

  • Arteriovenous malformation
  • Embolization
  • Endovascular
  • Hemorrhage
  • Meta-analysis
  • Review
  • Stereotactic radiosurgery
  • Stroke
  • Vascular disorders

ASJC Scopus subject areas

  • Surgery
  • Clinical Neurology

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