Impact of embolization on stereotactic radiosurgery outcomes for intracranial arteriovenous malformations Spetzler-Martin grades III–V: a systematic review and meta-analysis
Bibliographic record
Abstract
Introduction Intracranial arteriovenous malformations (AVMs) classified as Spetzler-Martin (SM) grades III-V present significant therapeutic challenges due to their complex angioarchitecture and high risk of morbidity. Stereotactic radiosurgery (SRS) is a minimally invasive modality for nidus obliteration, often combined with embolization to reduce nidus size and address high-risk vascular features. However, the impact of pre-SRS embolization on obliteration rates, post-SRS hemorrhage, and mortality remains controversial. This systematic review and meta-analysis aim to evaluate the effects of embolization on SRS outcomes in high-grade AVMs. Methods Following PRISMA guidelines, a comprehensive search of PubMed, ScienceDirect, Cochrane, and Google Scholar was conducted. Studies comparing SRS alone versus SRS with embolization in SM grade III-V AVMs were included. Primary outcomes were obliteration rates, post-SRS hemorrhage, and mortality. Data extraction and quality assessment were performed using the Newcastle-Ottawa Scale, and pooled analysis was conducted using Review Manager (RevMan) software. Results Out of 4,186 identified studies, five high-quality cohort studies met inclusion criteria. Pooled analysis showed that SRS alone resulted in higher obliteration rates than SRS with embolization (OR: 2.06, 95% CI: 0.92–4.65; p=0.08), though not statistically significant. Post-SRS hemorrhage rates were comparable (OR: 3.07, 95% CI: 0.72–13.08; p = 0.13), and mortality rates showed no significant difference (OR: 0.21, 95% CI: 0.01–4.62; p = 0.32). Discussion Although embolization aids in nidus volume reduction, it may hinder radiosurgical efficacy by altering nidus architecture and introducing shielding effects. SRS alone demonstrated superior obliteration rates with fewer technical concerns. Individualized treatment planning remains essential, balancing embolization benefits against its potential drawbacks. Future studies should explore advancements in embolic agents and imaging techniques to optimize multimodal strategies for high-grade AVMs.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.011 | 0.028 |
| Meta-epidemiology (narrow) | 0.002 | 0.001 |
| Meta-epidemiology (broad) | 0.016 | 0.035 |
| Bibliometrics | 0.007 | 0.008 |
| Science and technology studies | 0.001 | 0.001 |
| Scholarly communication | 0.003 | 0.001 |
| Open science | 0.002 | 0.001 |
| Research integrity | 0.002 | 0.001 |
| Insufficient payload (model declined to judge) | 0.003 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".