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Brainstem Cavernous Malformations Management: Microsurgery vs. Radiosurgery, a Meta-Analysis.

George Fotakopoulos1,2, Hugo Andrade-Barazarte1, Juri Kivelev3

  • 1Department of Neurosurgery, Henan Provincial People's Hospital, Zhengzhou, China.

Frontiers in Surgery
|January 27, 2022
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Summary

Microsurgical resection and stereotactic radiosurgery (SRS) for brainstem cavernous malformations (BSCMs) show no significant differences in mortality, rebleeding, or neurological deficits. Both treatments offer comparable outcomes for BSCMs.

Keywords:
brainstem cavernous malformationsmanagementmicrosurgeryoutcomesstereotactic radiosurgery

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Area of Science:

  • Neurosurgery
  • Neurology
  • Radiosurgery

Background:

  • Brainstem cavernous malformations (BSCMs) are rare neurological conditions.
  • Limited data exists comparing microsurgical resection and stereotactic radiosurgery (SRS) for BSCMs.

Purpose of the Study:

  • To systematically review and perform a meta-analysis comparing microsurgical resection and SRS for BSCMs.
  • To assess mortality, permanent neurological deficits (PNDs), rebleeding rates, and reintervention requirements for each modality.

Main Methods:

  • Systematic review and meta-analysis following PRISMA guidelines.
  • Included six articles encompassing 396 patients (168 microsurgery, 228 SRS).

Main Results:

  • No significant difference in mortality, late rebleeding rates, or PNDs between microsurgery and SRS.
  • Microsurgery eliminates immediate rehemorrhage risk but has similar PND rates to SRS.
  • SRS significantly reduces rebleeding risk within 2 years, with no remarkable difference compared to surgery.

Conclusions:

  • Microsurgical resection and SRS demonstrate comparable safety and efficacy profiles for BSCMs.
  • The choice of treatment should consider individual patient factors and lesion characteristics.