World neurosurgery · 2024
Stereotactic Radiosurgery for Intracranial Cavernous Malformations: International Stereotactic Radiosurgery Society, Systematic Review, Meta-Analysis, and Practice Guidelines.
СтатьяСистематический обзорМетаанализНазвание и аннотация: Перевод в очереди
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Tos Salem M, Shaaban Ahmed, Mantziaris Georgios, Dumot Chloe, Kotecha Rupesh, Fariselli Laura, Gorgulho Alessandra, Levivier Marc, Ma Lijun, Paddick Ian, Pollock Bruce E, Regis Jean, Suh John H, Yomo Shoji, Sahgal Arjun, Sheehan Jason P
Аннотация
OBJECTIVE: The International Stereotactic Radiosurgery Society aims to establish evidence-based guidelines for single-fraction stereotactic radiosurgery (SRS) in treating intracranial cavernous malformations.
METHODS: We conducted a systematic review following Preferred Reporting Items for Systematic Reviews and Meta-Analyses and Meta-analysis of Observational Studies in Epidemiology guidelines, searching electronic databases up to January 2024 to assess SRS's impact on post-treatment hemorrhage rates. Pooled risk ratios (RRs) and confidence intervals were used to quantify this effect, along with assessments of lesion volume changes, seizure outcomes, and SRS-related adverse effects.
RESULTS: Our meta-analysis included 32 studies with 2672 patients. A significant decrease in annual hemorrhage rates was observed post-treatment (RR = 0.17), with rates of RR = 0.29 in the first 2 years and RR = 0.11 thereafter. Hemorrhage rates significantly differed before and after 2 years post-SRS (RR = 0.36). Among epileptic patients, 20.2% had epilepsy pretreatment, and 49.9% were seizure-free post-SRS, while 30.6% experienced reduced seizure frequency. Lesion volume changes showed a reduction in 46.9%, stability in 47.1%, and an increase in 6.7%. Symptomatic radiation effects affected 8% of patients. Subgroup analysis revealed symptomatic change rates of 6% at doses ≤13 Gy compared to 9% at doses >13 Gy. Permanent clinical deficits were rare (2%).
CONCLUSIONS: This meta-analysis suggests SRS is an effective intervention for intracranial cavernous malformations, significantly reducing hemorrhage rates and improving seizure outcomes. International Stereotactic Radiosurgery Society practice guidelines are provided.
METHODS: We conducted a systematic review following Preferred Reporting Items for Systematic Reviews and Meta-Analyses and Meta-analysis of Observational Studies in Epidemiology guidelines, searching electronic databases up to January 2024 to assess SRS's impact on post-treatment hemorrhage rates. Pooled risk ratios (RRs) and confidence intervals were used to quantify this effect, along with assessments of lesion volume changes, seizure outcomes, and SRS-related adverse effects.
RESULTS: Our meta-analysis included 32 studies with 2672 patients. A significant decrease in annual hemorrhage rates was observed post-treatment (RR = 0.17), with rates of RR = 0.29 in the first 2 years and RR = 0.11 thereafter. Hemorrhage rates significantly differed before and after 2 years post-SRS (RR = 0.36). Among epileptic patients, 20.2% had epilepsy pretreatment, and 49.9% were seizure-free post-SRS, while 30.6% experienced reduced seizure frequency. Lesion volume changes showed a reduction in 46.9%, stability in 47.1%, and an increase in 6.7%. Symptomatic radiation effects affected 8% of patients. Subgroup analysis revealed symptomatic change rates of 6% at doses ≤13 Gy compared to 9% at doses >13 Gy. Permanent clinical deficits were rare (2%).
CONCLUSIONS: This meta-analysis suggests SRS is an effective intervention for intracranial cavernous malformations, significantly reducing hemorrhage rates and improving seizure outcomes. International Stereotactic Radiosurgery Society practice guidelines are provided.