Abstract：
BACKGROUND: Stereotactic radiosurgery is the preferred option for treating brain arteriovenous malformation (AVM) when the risks associated with surgery outweigh the potential benefits. However, some patients require repeat radiosurgery due to residual AVM after the first procedure. This systematic review and meta-analysis aimed to investigate the safety and efficacy of repeated procedure of radiosurgery for AVM.
METHODS: A systematic review was conducted according to the PRISMA guideline. The search was conducted on PubMed, Scopus, Embase, and Web of Science, using a pre-designed search string. Studies investigating the efficacy of repeat radiosurgery for residual AVM following initial single session radiosurgery were included. The risk of bias was assessed using the JBI tool. Meta-analysis and met-regression were performed to pool and inspect data.
RESULTS: Our meta-analysis, with a mean follow-up of 45.57 months, reveals repeat radiosurgery as a viable option for arteriovenous malformations (AVMs), achieving a 60.82% obliteration rate with a mean time to obliteration of 33.18 months. Meta-regression identifies AVM volume and Spetzler-Martin (SM) grade as factors influencing obliteration, with smaller volume and lower SM grades associated with higher rates. Complications include 10.33% radiation-induced changes, 5.26% post-radiosurgery hemorrhage, 2.56% neurologic deficits, and 0.67% cyst formation. Heterogeneity in complications is primarily attributed to male proportion and SM grade, while factors influencing post-radiosurgery hemorrhage remain unclear. The type of radiosurgery, whether Gamma Knife Radiosurgery (GKRS) or LINAC, does not significantly impact outcomes.
CONCLUSIONS: Repeat radiosurgery is a feasible, effective, and safe treatment for AVMs following failure of initial radiosurgery. When utilized in appropriate patient subgroups, it provides an acceptable risk-to-benefit profile. Feature studies are required to clarify its clear indications.
METHODS: A systematic review was conducted according to the PRISMA guideline. The search was conducted on PubMed, Scopus, Embase, and Web of Science, using a pre-designed search string. Studies investigating the efficacy of repeat radiosurgery for residual AVM following initial single session radiosurgery were included. The risk of bias was assessed using the JBI tool. Meta-analysis and met-regression were performed to pool and inspect data.
RESULTS: Our meta-analysis, with a mean follow-up of 45.57 months, reveals repeat radiosurgery as a viable option for arteriovenous malformations (AVMs), achieving a 60.82% obliteration rate with a mean time to obliteration of 33.18 months. Meta-regression identifies AVM volume and Spetzler-Martin (SM) grade as factors influencing obliteration, with smaller volume and lower SM grades associated with higher rates. Complications include 10.33% radiation-induced changes, 5.26% post-radiosurgery hemorrhage, 2.56% neurologic deficits, and 0.67% cyst formation. Heterogeneity in complications is primarily attributed to male proportion and SM grade, while factors influencing post-radiosurgery hemorrhage remain unclear. The type of radiosurgery, whether Gamma Knife Radiosurgery (GKRS) or LINAC, does not significantly impact outcomes.
CONCLUSIONS: Repeat radiosurgery is a feasible, effective, and safe treatment for AVMs following failure of initial radiosurgery. When utilized in appropriate patient subgroups, it provides an acceptable risk-to-benefit profile. Feature studies are required to clarify its clear indications.
摘要：
背景：当与手术相关的风险超过潜在益处时，立体定向放射外科是治疗脑动静脉畸形（AVM）的首选选择。然而,一些患者在第一次手术后由于残留的AVM而需要再次进行放射外科治疗.本系统评价和荟萃分析旨在探讨反复手术治疗AVM的安全性和有效性。
方法：根据PRISMA指南进行系统评价。搜索是在PubMed上进行的，Scopus,Embase,和WebofScience,使用预先设计的搜索字符串。包括研究首次单次放射外科手术后重复放射外科手术对残留AVM的疗效的研究。使用JBI工具评估偏倚风险。进行荟萃分析和met回归分析以收集和检查数据。
结果：我们的荟萃分析，平均随访45.57个月，揭示了重复放射外科手术作为动静脉畸形（AVM）的可行选择，达到60.82%的消失率，平均消失时间为33.18个月。元回归将AVM体积和Spetzler-Martin(SM)等级确定为影响闭塞的因素，较小的体积和较低的SM等级与较高的费率相关。并发症包括10.33%的辐射引起的变化，5.26%放射外科术后出血，2.56%神经缺陷，和0.67%的囊肿形成。并发症的异质性主要归因于男性比例和SM等级，而影响放射外科术后出血的因素仍不清楚。放射外科的类型,无论是伽玛刀放射外科（GKRS）还是LINAC，不会显著影响结果。
结论：重复放射外科手术是可行的，有效,以及初始放射外科失败后AVM的安全治疗。当用于适当的患者亚组时，它提供了可接受的风险-收益概况。需要进行特征研究以阐明其明确的适应症。
方法：根据PRISMA指南进行系统评价。搜索是在PubMed上进行的，Scopus,Embase,和WebofScience,使用预先设计的搜索字符串。包括研究首次单次放射外科手术后重复放射外科手术对残留AVM的疗效的研究。使用JBI工具评估偏倚风险。进行荟萃分析和met回归分析以收集和检查数据。
结果：我们的荟萃分析，平均随访45.57个月，揭示了重复放射外科手术作为动静脉畸形（AVM）的可行选择，达到60.82%的消失率，平均消失时间为33.18个月。元回归将AVM体积和Spetzler-Martin(SM)等级确定为影响闭塞的因素，较小的体积和较低的SM等级与较高的费率相关。并发症包括10.33%的辐射引起的变化，5.26%放射外科术后出血，2.56%神经缺陷，和0.67%的囊肿形成。并发症的异质性主要归因于男性比例和SM等级，而影响放射外科术后出血的因素仍不清楚。放射外科的类型,无论是伽玛刀放射外科（GKRS）还是LINAC，不会显著影响结果。
结论：重复放射外科手术是可行的，有效,以及初始放射外科失败后AVM的安全治疗。当用于适当的患者亚组时，它提供了可接受的风险-收益概况。需要进行特征研究以阐明其明确的适应症。
