Stereotactic radiosurgery for spetzler-martin grade i and II arteriovenous malformations: International society of stereotactic radiosurgery (ISRS) practice guideline

Christopher S. Graffeo, Arjun Sahgal, Antonio de Salles, Laura Fariselli, Marc Levivier, Lijun Ma, Ian Paddick, Jean Marie Regis, Jason Sheehan, John Suh, Shoji Yomo, Bruce E. Pollock

Research output: Contribution to journalReview articlepeer-review

Abstract

BACKGROUND: No guidelines have been published regarding stereotactic radiosurgery (SRS) in the management of Spetzler-Martin grade I and II arteriovenous malformations (AVMs). OBJECTIVE: To establish SRS practice guidelines for grade I-II AVMs on the basis of a systematic literature review. METHODS: Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA)-compliant search of Medline, Embase, and Scopus, 1986-2018, for publications reporting post-SRS outcomes in ≥10 grade I-II AVMs with a follow-up of ≥24 mo. Primary endpoints were obliteration and hemorrhage; secondary outcomes included Spetzler-Martin parameters, dosimetric variables, and “excellent” outcomes (defined as total obliteration without new post-SRS deficit). RESULTS: Of 447 abstracts screened, 8 were included (n = 1, level 2 evidence; n = 7, level 4 evidence), representing 1102 AVMs, of which 836 (76%) were grade II. Obliteration was achieved in 884 (80%) at a median of 37 mo; 66 hemorrhages (6%) occurred during a median follow-up of 68 mo. Total obliteration without hemorrhage was achieved in 78%. Of 836 grade II AVMs, Spetzler-Martin parameters were reported in 680: 377 were eloquent brain and 178 had deep venous drainage, totaling 555/680 (82%) high-risk SRS-treated grade II AVMs. CONCLUSION: The literature regarding SRS for grade I-II AVM is low quality, limiting interpretation. Cautiously, we observed that SRS appears to be a safe, effective treatment for grade I-II AVM and may be considered a front-line treatment, particularly for lesions in deep or eloquent locations. Preceding publications may be influenced by selection bias, with favorable AVMs undergoing resection, whereas those at increased risk of complications and nonobliteration are disproportionately referred for SRS.

Original languageEnglish
Pages (from-to)442-452
Number of pages11
JournalNeurosurgery
Volume87
Issue number3
DOIs
Publication statusPublished - Sep 1 2020

Keywords

  • Arteriovenous malformation
  • Guidelines
  • Selection bias
  • Spetzler-Martin grade
  • Stereotactic radiosurgery

ASJC Scopus subject areas

  • Surgery
  • Clinical Neurology

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