Departments of Pediatric Neurosurgery Children's Medical Center Hospital, Tehran University of Medical Sciences, Tehran, Iran.
Interdisciplinary Neuroscience Research Program, Tehran University of Medical Sciences, Tehran, Iran.
Neurosurg Rev. 2023 Jun 26;46(1):148. doi: 10.1007/s10143-023-02059-4.
Deep-seated unruptured AVMs located in the thalamus, basal ganglia, or brainstem have a higher risk of hemorrhage compared to superficial AVMs and surgical resection is more challenging. Our systematic review and meta-analysis provide a comprehensive summary of the stereotactic radiosurgery (SRS) outcomes for deep-seated AVMs. This study follows the guidelines set forth by the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) Statement. We conducted a systematic search in December 2022 for all reports of deep-seated arteriovenous malformations treated with SRS. Thirty-four studies (2508 patients) were included. The mean obliteration rate in brainstem AVM was 67% (95% CI: 0.60-0.73), with significant inter-study heterogeneity (tau = 0.0113, I = 67%, chi = 55.33, df = 16, p-value < 0.01). The mean obliteration rate in basal ganglia/thalamus AVM was 65% (95% CI: 0.58-0.72) with significant inter-study heterogeneity (tau = 0.0150, I = 78%, chi = 81.79, df = 15, p-value < 0.01). The presence of deep draining veins (p-value: 0.02) and marginal radiation dose (p-value: 0.04) were positively correlated with obliteration rate in brainstem AVMs. The mean incidence of hemorrhage after treatment was 7% for the brainstem and 9% for basal ganglia/thalamus AVMs (95% CI: 0.05-0.09 and 95% CI: 0.05-0.12, respectively). The meta-regression analysis demonstrated a significant positive correlation (p-value < 0.001) between post-operative hemorrhagic events and several factors, including ruptured lesion, previous surgery, and Ponce C classification in basal ganglia/thalamus AVMs. The present study found that radiosurgery appears to be a safe and effective modality in treating brainstem, thalamus, and basal ganglia AVMs, as evidenced by satisfactory rates of lesion obliteration and post-surgical hemorrhage.
深部未破裂动静脉畸形位于丘脑、基底节或脑干，与表浅动静脉畸形相比，出血风险更高，手术切除更具挑战性。我们的系统评价和荟萃分析提供了深部动静脉畸形立体定向放射外科（SRS）治疗结果的综合总结。本研究遵循系统评价和荟萃分析首选报告项目（PRISMA）声明的准则。我们于 2022 年 12 月对所有接受 SRS 治疗的深部动静脉畸形的报告进行了系统检索。纳入 34 项研究（2508 例患者）。脑干 AVM 的平均闭塞率为 67%（95%CI：0.60-0.73），存在显著的研究间异质性（tau = 0.0113，I = 67%，chi = 55.33，df = 16，p 值<0.01）。基底节/丘脑 AVM 的平均闭塞率为 65%（95%CI：0.58-0.72），存在显著的研究间异质性（tau = 0.0150，I = 78%，chi = 81.79，df = 15，p 值<0.01）。深引流静脉的存在（p 值：0.02）和边缘辐射剂量（p 值：0.04）与脑干 AVM 的闭塞率呈正相关。脑干 AVM 治疗后出血的平均发生率为 7%，基底节/丘脑 AVM 为 9%（95%CI：0.05-0.09 和 95%CI：0.05-0.12）。元回归分析表明，术后出血事件与几个因素呈显著正相关（p 值<0.001），包括基底节/丘脑 AVM 的破裂病变、既往手术和 Ponce C 分类。本研究发现，放射外科似乎是治疗脑干、丘脑和基底节动静脉畸形的一种安全有效的方法，病变闭塞率和术后出血率均令人满意。
