Microsurgical resection versus stereotactic radiosurgery for low-grade intracranial arteriovenous malformations: A 27-year institutional experience

Gami, Abhishek; Feghali, James; Rapaport, Sarah; Sattari, Shahab Aldin; Yang, Wuyang; Tamargo, Rafael J.; Caplan, Justin M.; Huang, Judy

doi:10.1016/j.jocn.2021.10.036

Cited by 5 publications

(8 citation statements)

References 24 publications

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“…Therefore, 8 studies were included in this meta-analysis (Figure 1). [20][21][22][23][24][25][26][27]…”

Section: Study Selectionmentioning

confidence: 99%

“…In this review, ruptured bAVMs (50% vs 36%, P = .01) and adjunctive embolization (49% vs 21%, P < .001) were higher in the microsurgery group; however, the mean age (42 vs 42, P = .89), male sex (49% vs 46%, P = .56), SM grade (Ⅰ-Ⅱ 64% vs 61%; Ⅲ 27% vs 29%; Ⅳ-Ⅴ 8% vs 8%, P = .64), mean nidus size (2.7 vs 2.3, P = .18), infratentorial location (12% vs 11%, P = .78), deep venous drainage (38.4% vs 40.6%, P = .58), eloquent bAVMs (49% vs 58%, P = .15), and length of follow-up (year) (2.4 vs 4.6, P = .05) were similar between the groups (Table 1). The types of radiosurgery were linear accelerator, 20 Gamma knife, 21,[23][24][25] Gamma knife, or Cyberknife 27 and not reported by 2 studies. 22,26…”

Section: Study Characteristicsmentioning

confidence: 99%

“…Eight studies reported obliteration. [20][21][22][23][24][25][26][27] The OR of bAVMs obliteration was higher with microsurgery (95% vs 53%, OR = 18.51 [11.05, 31.01], P < .000001, I 2 = 0, P = .81; Figure 3A). The certainty of the evidence was high.…”

Section: Meta-analysis Of the Outcomes Primary Outcomes Brain Avm Obl...mentioning

confidence: 99%

“…Seven studies reported follow-up hemorrhage. [20][21][22][23][24][25][26][27] The HR of follow-up hemorrhage was lower with microsurgery (HR = 0.47 [0.23, 0.97], P = .04, I 2 = 23%, P = .26; Figure 4). The certainty of the evidence was moderate.…”

Section: Follow-up Hemorrhagementioning

confidence: 99%

“…Permanent neurological deficit Seven studies reported PND. [20][21][22][23][24][25][26][27] The OR of the PND was higher with microsurgery (14.6% vs 5.3%, OR = 2.85 [1.63, 4.97], P = .0002, I 2 = 0%, P = .90; Figure 5A). The certainty of the evidence was low.…”

Section: Secondary Outcomesmentioning

confidence: 99%

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Microsurgery Versus Stereotactic Radiosurgery for Treatment of Patients With Brain Arteriovenous Malformation: A Systematic Review and Meta-Analysis

et al. 2023

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BACKGROUND: Treatment decision-making for brain arteriovenous malformations (bAVMs) with microsurgery or stereotactic radiosurgery (SRS) is controversial. OBJECTIVE: To conduct a systematic review and meta-analysis to compare microsurgery vs SRS for bAVMs. METHOD: Medline and PubMed were searched from inception to June 21, 2022. The primary outcomes were obliteration and follow-up hemorrhage, and secondary outcomes were permanent neurological deficit, worsened modified Rankin scale (mRS), follow-up mRS > 2, and mortality. The GRADE approach was used for grading the level of evidence. RESULTS: Eight studies were included, which yielded 817 patients, of which 432 (52.8%) and 385 (47.1%) patients underwent microsurgery and SRS, respectively. Two cohorts were comparable in age, sex, Spetzler-Martin grade, nidus size, location, deep venous drainage, eloquence, and follow-up. In the microsurgery group, the odds ratio (OR) of obliteration was higher (OR = 18.51 [11.05, 31.01], P < .000001, evidence: high) and the hazard ratio of follow-up hemorrhage was lower (hazard ratio = 0.47 [0.23, 0.97], P = .04, evidence: moderate). The OR of permanent neurological deficit was higher with microsurgery (OR = 2.85 [1.63, 4.97], P = .0002, evidence: low), whereas the OR of worsened mRS (OR = 1.24 [0.65, 2.38], P = .52, evidence: moderate), follow-up mRS > 2 (OR = 0.78 [0.36, 1.7], P = .53, evidence: moderate), and mortality (OR = 1.17 [0.41, 3.3], P = .77, evidence: moderate) were comparable between the groups. CONCLUSION: Microsurgery was superior at obliterating bAVMs and preventing further hemorrhage. Despite a higher rate of postoperative neurological deficit with microsurgery, functional status and mortality were comparable with patients who underwent SRS. Microsurgery should remain a first-line consideration for bAVMs, with SRS reserved for inaccessible locations, highly eloquent areas, and medically high-risk or unwilling patients.

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“…Therefore, 8 studies were included in this meta-analysis (Figure 1). [20][21][22][23][24][25][26][27]…”

Section: Study Selectionmentioning

confidence: 99%