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Meta-Analysis
. 2024 Apr 24;47(1):186.
doi: 10.1007/s10143-024-02434-9.

Stereotactic radiosurgery for intracranial cavernous malformations of the deep-seated locations: systematic review and meta-analysis

Salem M Tos  1 , Georgios Mantziaris  1 , Ahmed Shaaban  1 , Jason P Sheehan  2
Affiliations
Meta-Analysis

Stereotactic radiosurgery for intracranial cavernous malformations of the deep-seated locations: systematic review and meta-analysis

Salem M Tos et al. Neurosurg Rev. .

Abstract

Objective: To determine the outcomes of stereotactic radiosurgery (SRS) for deep-seated (brainstem, basal ganglia, thalamus, cerebellar peduncle) intracranial cavernous malformations (ICMs).

Methods: A systematic review and meta-analysis was performed according to PRISMA and MOOSE guidelines. The main outcomes were comparing pre- and post-SRS hemorrhage rates, using the pooled risk ratios (RR) as the measure of effect. Additionally, the study assessed lesion volume changes and radiation-injury incidence.

Results: Data of 850 patients across 14 studies were included in the meta-analysis. The pooled RR of all deep-seated ICMs show a decrease in hemorrhage rate after SRS compared to pre-SRS over the total follow-up period (RR =0.13), initial 2 years (RR =0.22), and after 2 years (RR =0.07). For 9 studies that reported hemorrhage rate of the brainstem only, the pooled RR shows a decrease of hemorrhage rate after SRS compared to pre-SRS over the total follow-up period (RR =0.13), initial 2 years (RR =0.19), and after 2 years (RR =0.07). Volumetric regression was achieved in 44.25% and stability in 56.1%. The pooled incidence of symptomatic and permanent radiation injury was 9% (95% CI, 7-11) and 3% (95% CI, 0-1.9%), respectively.

Conclusion: SRS appears effective in reducing hemorrhage rates for deep-seated ICMs. The risk of symptomatic radiation injury is low. Given the high risk of surgical morbidity, SRS is a reasonable treatment option for patients with deep-seated ICMs with at least one prior hemorrhage.

Keywords: Adverse radiation effect; Cavernoma; Cavernous malformation; Deep-seated; Hemorrhage; Intracranial; SRS.

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Conflict of interest statement

The authors declared no personal, financial, or institutional interests related to the drugs, materials, or devices discussed in the article.

The authors declare no competing interests.

Figures

Fig. 1
Fig. 1
PRISMA flow chart of study selection process
Fig 2
Fig 2
Forest plots of annual hemorrhage rate comparing pre-SRS and total post-SRS (A), pre-SRS and first 2 years post-SRS (B), pre-SRS and after 2 years post-SRS (C), and first 2 years post SRS and after 2 years post-SRS (D)
See this image and copyright information in PMC

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