• Byung Sup Kim, Kyung Hwan Kim, Min Ho Lee, and Jung-Il Lee.
• Department of Neurosurgery, Kosin University Gospel Hospital, Kosin University College of Medicine, Busan, Republic of Korea. Electronic address: skysareblue@gmail.com.
• World Neurosurg. 2019 Oct 1; 130: e648-e659.

ObjectiveThis study was conducted to achieve more conclusive evidence for the efficacy of stereotactic radiosurgery (SRS) for brainstem cavernous malformations (BSCMs).MethodsA literature search of PubMed, EMBASE, and Web of Science was performed and studies reporting the outcomes of SRS for BSCMs were included. The primary outcome was the pre-SRS and post-SRS hemorrhage rates; the pooled incidence rate ratio (IRR) with 95% confidence interval was chosen as effect size. Lesion control, symptom change, and radiation-related complications were evaluated.ResultsA total of 576 patients across 14 studies were included in this meta-analysis. The post-SRS hemorrhage rate was significantly decreased compared with the pre-SRS rate (IRR, 0.123; P < 0.001), and the hemorrhage rate 2 years after SRS was significantly lower than that within 2 years after SRS (IRR, 0.317; P < 0.001). Ten among 14 studies have shown that the symptoms were improved or stationary after SRS. Lesion volume was reduced in 47.3% of the patients and was stationary in 49.4% on the last follow-up images. Symptomatic adverse radiation effects (AREs) developed in 7.3% and permanent AREs were observed in 2.2%. In subgroup analysis, studies having mean marginal dose of ≤13 Gy showed statistically significantly lower development of symptomatic AREs than those having mean marginal dose of >13Gy (2.0% vs. 10.8%; P = 0.008).ConclusionsSRS using a relatively low marginal dose can be a safe and effective treatment for BSCM. Further prospective studies are necessary to confirm the optimal radiation dose and efficacy of SRS for BSCMs.Copyright © 2019 Elsevier Inc. All rights reserved.

15 keywords...

hide…