Stereotactic Radiosurgery for Brainstem Cavernous Malformations: An Updated Systematic Review and Meta-Analysis

Area of Science:

• Neurosurgery
• Radiation Oncology
• Neurology

Background:

• Brainstem cavernous malformations (BSCMs) pose significant risks due to their location.
• Stereotactic radiosurgery (SRS) is a treatment option, but its efficacy and safety for BSCMs require further evidence.

Purpose of the Study:

• To provide conclusive evidence on the efficacy and safety of SRS for BSCMs.
• To analyze hemorrhage rates, lesion control, symptom changes, and radiation-related complications.

Main Methods:

• A meta-analysis of 14 studies involving 576 patients treated with SRS for BSCMs.
• Literature search conducted across PubMed, EMBASE, and Web of Science.
• Primary outcome: pre- and post-SRS hemorrhage rates analyzed using pooled incidence rate ratio (IRR).

Main Results:

• SRS significantly decreased post-treatment hemorrhage rates compared to pre-treatment rates (IRR, 0.123; P < 0.001).
• Hemorrhage rates were lower 2 years post-SRS than within 2 years (IRR, 0.317; P < 0.001).
• Symptomatic adverse radiation effects (AREs) occurred in 7.3% of patients, with permanent AREs in 2.2%. Lower marginal doses (≤13 Gy) were associated with fewer symptomatic AREs (2.0% vs. 10.8%; P = 0.008).

Conclusions:

• Stereotactic radiosurgery (SRS) is a safe and effective treatment for brainstem cavernous malformations (BSCMs), particularly when using a low marginal dose.
• Further prospective studies are recommended to confirm optimal radiation doses and long-term efficacy of SRS for BSCMs.