To investigate role of stereotactic radiosurgery as a first and primary treatment in the management of Arteriovenous Malformations in an Adult Population.

Abstract

Stereotactic radiosurgery (SRS) is widely used as treatment option for brain arteriovenous malformations (BAVM), however the extent of it’s role remains undefined. Research to date is gathered collectively from groups which consider SRS, embolisation and microsurgery as a single interventional technique or from reports in which SRS is provided as a secondary treatment. The evidence for SRS is representative of an accumulation of techniques and thus inconclusive for the individual contribution of SRS. The aim of the systematic review was to establish the role of SRS as a primary treatment in the obliteration of AVMs. An extensive literature search was conducted on Embase, CINAHL and Pudmed databases. This was followed by a rigid, pre-defined screening of the collected literature. For all included studies SRS was provided as a first and primary treatment for multiple grade BAVMs in an adult population. Statistical analysis was completed using Comprehensive meta-analysis software and was also accompanied by tabular summary and narrative analysis. 11 Studies were included in the final analysis. Despite an I² statistic of 71.87 for heterogeneity results indicated a trend supporting the role of SRS as a treatment, particularly for the obliteration of smaller BAVMs. Due to a small sample size in result analysis it was advised to interpret results with caution. Considering the non-invasive approach of SRS it may also hold a major advantage in treatment of large, deep BAVMs (IRSA 2009). The review identified the need to establish correct dose contributions for various BAVM sizes and grades. It also revealed that consistent reporting is strongly advised particularly for considerations such as age and pre-treatment embolisation. Future research is vital and necessary to establish the therapeutic advantage SRS may play in AVM obliteration and to compare its efficacy against alternative treatment modalities such as embolisation or microsurgery.