Radiocirugía estereotáctica en malformaciones arteriovenosas cerebrales

Abstract

Introduction: Cerebral arteriovenous malformations (AVMs) alter the blood vessel anatomy, presenting direct arteriovenous communication. The abnormal anatomophysiological hierarchy prevents the formation of blood capillaries and the standard passage of arteriovenous flow. The alteration of perfusion and flow are high-risk factors for rupture-producing intracerebral hemorrhage in 71% of cases. Different treatment options have been proposed, such as clinical management and invasive methods such as microsurgery, embolization, stereotactic radiosurgery (SRS), and multimodal therapy. Objective: To analyze the current scientific evidence identifying the treatment effectiveness of AVMs by stereotactic radiosurgery versus others. Methods: A Systematic Review was performed based on the PRISMA 2020 Standard in scientific databases with high-impact journals. Results: Eighteen articles were obtained with the systematic review from 2018 to 2023. It was evidenced that AVM presented an obliteration rate of 72.5% in ruptured and non-ruptured AVMs. The SRS effectiveness has improved by 10 % in the last five years. Also, post-SRS mortality was 0.7 % —lower than other treatment alternatives for AVMs—. Conclusions: SRS for the management of cerebral AVMs has evolved. Indeed, remarkable improvements in outcomes were observed: increased obliteration rates, reduced mortality, and better results in Spetzler-Martin Grade 3, 4, and 5 AVMs. It is considered a safe option for managing patients with multiple AVMs.