尚未发布有关Spetzler-MartinI级和II级动静脉畸形(AVM)的立体定向放射外科(SRS)的指南。
在系统文献综述的基础上,为I-II级AVM建立SRS实践指南。
符合系统审查和荟萃分析(PRISMA)的首选报告项目搜索Medline,Embase,还有Scopus,1986-2018年,用于报告≥10个I-II级AVM的SRS后结果的出版物,随访时间≥24个月。主要终点是闭塞和出血;次要终点包括Spetzler-Martin参数,剂量测定变量,和“优秀”结果(定义为没有新的SRS后赤字的完全消失)。
在筛选的447篇摘要中,包括8个(n=1,2级证据;n=7,4级证据),代表1102个AVM,其中836人(76%)为二级。884例(80%)在中位数为37个月时实现了闭塞;在中位数为68个月的随访中发生了66例出血(6%)。78%的患者实现了无出血的完全闭塞。在836个二级AVM中,在680中报告了Spetzler-Martin参数:377是雄辩的大脑,178有深静脉引流,总计555/680(82%)高风险SRS处理的II级AVM。
关于I-II级AVM的SRS的文献质量较低,限制性解释。谨慎地,我们观察到SRS似乎是安全的,I-II级AVM的有效治疗,可以被认为是一线治疗,特别是在深或有说服力的位置的病变。前面的出版物可能会受到选择偏差的影响,有利的AVM正在切除,而那些并发症和非闭塞风险增加的患者被推荐为SRS患者比例较高.
No
guidelines have been published regarding stereotactic radiosurgery (SRS) in the management of Spetzler-Martin grade I and II arteriovenous malformations (AVMs).
To establish SRS practice
guidelines for grade I-II AVMs on the basis of a systematic literature review.
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).
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.
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.