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The impact of embolization on radiosurgery obliteration rates for brain arteriovenous malformations: a systematic review and meta‐analysis

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Abstract

There exists no consensus in the literature regarding the impact of pre-stereotactic radiosurgery (SRS) embolization on obliteration rates and clinical outcome after radiosurgery treatment of intracranial arteriovenous malformations (AVM). We performed a systematic review of four databases and included studies with at least 10 patients evaluating obliteration rates of intracranial AVMs treated with SRS alone (SRS cohort) and combined pre-SRS embolization followed by SRS (E + SRS cohort). Meta-analytic results were pooled together via random-effects models. A total of 43 studies, with 7103 patients, were included in our analysis. Among our included patients, complete obliteration was achieved in 51.5% (964/1871) of patients in the E + SRS cohort as compared to 61.5% (3217/5231) of patients in the SRS cohort. Meta-analysis of the pooled data revealed that obliteration was significantly lower in the E + SRS cohort (pooled OR = 0.64, 95% CI = 0.54–0.75, p < 0.0001). The use of pre-SRS embolization was significantly associated with lower AVM obliteration rates when compared to treatment with SRS alone. Our analysis seeks to provide a macroscopic insight into the complex interaction between pre-SRS embolization and brain AVM obliteration rates and prognosis. Pre-SRS embolization may still be beneficial in select patients, and further studies are needed to identify patients who benefit from neoadjuvant AVM embolization.

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Abbreviations

AVM:

Arteriovenous malformation

SRS:

Stereotactic radiosurgery

SM:

Spetzler-Martin

E + SRS cohort:

Pre-SRS Embolization with SRS cohort

SRS cohort:

SRS-only cohort

MRA:

Magnetic resonance angiography

DSA:

Digital subtraction angiography

RIC:

Radiation-induced changes

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Authors and Affiliations

  1. Department of Neurosurgery, University of Miami Miller School of Medicine, Jackson Memorial Hospital, 1095 NW 14th Terrace, Miami, FL, USA

    Henry Chang, Michael A. Silva, Evan Luther & Robert M. Starke

  2. Florida State University College of Medicine, Tallahassee, FL, USA

    John Weng

  3. University of Florida College of Medicine, Gainesville, FL, USA

    Jasmina Kovacevic

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Contributions

Conception and design: H.C., M.S., E.L., R.S. Acquisition of data: H.C., J.W., J.K. Analysis and interpretation of data: All authors. Drafting the article: H.C., J.W., J.K. Critically revising the article: H.C., M.S., E.L. R.S. Reviewed submitted version of manuscript: H.C., M.S., E.L., R.S. Statistical analysis: H.C., J.W., J.K. Administrative/technical/material support: M.S., E.L., R.S. Study supervision: M.S., E.L., R.S.

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Chang, H., Silva, M.A., Weng, J. et al. The impact of embolization on radiosurgery obliteration rates for brain arteriovenous malformations: a systematic review and meta‐analysis. Neurosurg Rev 46, 28 (2023). https://doi.org/10.1007/s10143-022-01935-9

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