SURG-11. Efficacy of Radiosurgery with and without Angioembolization:A Subgroup Analysis of Effectiveness in Ruptured versusUnruptured Arteriovenous Malformations.An Updated Systematic Review and Meta-Analysis

Abstract INTRODUCTION Congenital arterial defects such cerebral arteriovenous malformations increase brain bleeding risk. Conservative therapy, microsurgical removal, percutaneous embolization, stereotactic radiosurgery (SRS), or a combination may treat this serious disease. This study compares angioembolization with SRS to SRS alone in ruptured or unruptured BAVM patients. Methodology: We followed PRISMA recommendations for this study. Until September 2023, PubMed/Medline, Cochrane, and Clinicaltrials.gov were searched for literature. English-language studies comparing SRS alone to embolization with SRS on ruptured or non-ruptured AVMs that couldn’t be operated on were considered. The Newcastle Ottawa Scale assessed research study quality. RESULTS Results included 46 studies with a total of 7077 participants. There was a greater obliteration rate in the SRS-only group (60.4%) than in the embolization plus SRS group (49.73%). Particularly in the SRS-only group, ruptured AVMs showed a noticeably greater obliteration rate than unruptured AVMs (p=0.002). However no notable differences were found in hemorrhagic events or radiation-induced changes between the two groups, however the SRS-only group had a slightly greater, yet not statistically significant mortality rate. CONCLUSION Our data showed that ruptured brain AVMs had a much greater obliteration rate than unruptured ones, mostly due to SRS alone, without embolization. The aggregated data showed no significant changes, whereas SRS alone decreased radiation-induced alterations and hemorrhagic rates but with increased mortality. SRS alone may have a higher risk-to-reward ratio for nidus obliteration in ruptured brain AVM patients, so it should be used without embolization, although more research is needed to determine the effects of immediate and late complications.