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

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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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Data availability

No datasets were generated or analysed during the current study.

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Author notes

  1. Seyed Farzad Maroufi and Mohammad Amin Habibi contributed equally to this work.

Authors and Affiliations

  1. Neurosurgical Research Network (NRN), Universal Scientific Education and Research Network (USERN), Tehran, Iran

    Seyed Farzad Maroufi

  2. Department of Neurosurgery, Tehran University of Medical Sciences, Tehran, Iran

    Seyed Farzad Maroufi

  3. Department of Neurosurgery, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran

    Mohammad Amin Habibi

  4. School of Medicine, Qom University of Medical Sciences, Qom, Iran

    Mohammad Sina Mirjani

  5. School of Medicine, Bushehr University of Medical Sciences, Bushehr, Iran

    Ayoob Molla

  6. Student Research Committee, Qom University of Medical Sciences, Qom, Iran

    Nafise Pabarja

  7. Student’s Scientific Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran

    Mahdi Mehmandoost

  8. Department of Neurological Surgery, University of Virginia, Charlottesville, USA

    Jason P. Sheehan

  9. Department of Neurosurgery, Sina Hospital, Tehran University of Medical Sciences, Tehran, Iran

    Arad Iranmehr

  10. Gamma Knife Radiosurgery Centre, Yas Hospital, Tehran University of Medical Sciences, Tehran, Iran

    Arad Iranmehr

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Contributions

AI, JPS, SFM: Study conception and design; MAH, SFM, MSM: Writing the primary draft; AM, NP, MM, MAH: Data gathering; SFM: Statistical analysis; JPS and AI: Review and revised the manuscript; AI: Supervision; All authors approved the final version of the manuscript.

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Correspondence to Arad Iranmehr.

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Maroufi, S.F., Habibi, M.A., Mirjani, M.S. et al. Repeat single-session stereotactic radiosurgery for arteriovenous malformation: a systematic review and meta-analysis. Neurosurg Rev 47, 203 (2024). https://doi.org/10.1007/s10143-024-02438-5

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