A Comprehensive Meta-Analysis on the Efficacy of Stereotactic Radiosurgery versus Surgical Resection for Cerebral Arteriovenous Malformations

BACKGROUND: Cerebral arteriovenous malformations (AVMs) pose significant management challenges, with treatment options such as stereotactic radiosurgery (SRS) and surgical resection (SR) often debated. This meta-analysis seeks to compare the efficacy and safety of SRS versus SR in treating cerebral AVMs. METHODS: A comprehensive search was conducted across multiple databases adhering to Preferred Reporting Items for Systematic Reviews and Meta- Analyses guidelines. Inclusion criteria encompassed studies comparing SRS and SR with respect to AVM obliteration, hemorrhagic complications, and functional neurological outcomes. Data synthesis involved calculating standardized mean differences (SMD) for continuous variables and risk ratios for dichotomous outcomes, with heterogeneity assessed using the I2 statistic. RESULTS: Eight studies met the inclusion criteria. SRS was associated with a lower incidence of postoperative embolization (SMD =-6.58; 95% CI: [-9.49,-3.67]; I2 = 94%). Additionally, SRS demonstrated a reduced risk of postoperative hemorrhage (SMD =-14.45; 95% CI: [-21.58,-7.32]; I2 = 99%). The analysis also indicated a shorter mean operative time for SRS (SMD =-4.08; 95% CI: [-7.01,-1.16]; I2 = 94%). Moreover, SRS resulted in fewer postoperative neurologic deficits (SMD =-3.64; 95% CI: [-4.74,-2.55]; I2 = 90%). CONCLUSIONS: SRS appears to offer several advantages over SR, including lower rates of embolization, hemorrhage, shorter operative times, and fewer neurologic deficits post-treatment. These findings suggest SRS may be a preferable treatment modality for cerebral AVMs, particularly for lesions located in eloquent brain regions or in patients where traditional surgery presents significant risks.