Object Seizures are a common presentation of cerebral arteriovenous malformations (AVMs). The authors evaluated the efficacy of stereotactic radiosurgery (SRS) for the management of seizures associated with AVMs and identified factors influencing seizure outcomes following SRS for AVMs. Methods A systematic literature review was performed using PubMed. Studies selected for review were published in English, included at least 5 patients with both cerebral AVMs and presenting seizures treated with SRS, and provided post-SRS outcome data regarding obliteration of AVMs and/or seizures. Demographic, radiosurgical, radiological, and seizure outcome data were extracted and analyzed. All seizure outcomes were categorized as follows: 1) seizure free, 2) seizure improvement, 3) seizure unchanged, and 4) seizure worsened. Systematic statistical analysis was conducted to assess the effect of post-SRS AVM obliteration on seizure outcome. Results Nineteen case series with a total of 3971 AVM patients were included for analysis. Of these, 28% of patients presented with seizures, and data for 997 patients with available seizure outcome data who met the inclusion criteria were evaluated. Of these, 437 (43.8%) patients achieved seizure-free status after SRS, and 530 (68.7%) of 771 patients with available data achieved seizure control (seizure freedom or seizure improvement) following SRS. Factors associated with improved seizure outcomes following SRS for AVMs were analyzed in 9 studies. Seizure-free status was achieved in 82% and 41.0% of patients with complete and incomplete AVM obliteration, respectively. Complete AVM obliteration offered superior seizure-free rates compared with incomplete AVM obliteration (OR 6.13; 95% CI 2.16–17.44; p = 0.0007). Conclusions Stereotactic radiosurgery offers favorable seizure outcomes for AVM patients presenting with seizures. Improved seizure control is significantly more likely with complete AVM obliteration.
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机译：癫痫发作是脑动静脉畸形（AVM）的常见表现。作者评估了立体定向放射外科手术（SRS）处理与AVM相关的癫痫发作的功效，并确定了影响AVM的SRS术后癫痫发作结果的因素。方法使用PubMed进行系统的文献综述。选择进行审查的研究以英文发表，包括至少5例同时患有脑AVM并呈现SRS发作的患者，并提供了SRS术后有关AVM消失和/或癫痫发作的结局数据。人口统计，放射外科，放射学和癫痫发作的结果数据被提取和分析。所有癫痫发作的结果分类如下：1）无癫痫发作，2）癫痫发作改善，3）癫痫发作无变化，4）癫痫发作恶化。进行系统统计分析以评估SRS后AVM闭塞对癫痫发作结局的影响。结果共纳入19例病例，共3971名AVM患者进行了分析。在这些患者中，评估了28％的癫痫发作患者和997名符合纳入标准的癫痫发作可用数据患者。其中，有437例（43.8％）的患者在SRS后达到无癫痫状态，而在771例有可用数据的患者中，有530例（68.7％）在SRS后达到了癫痫发作控制（癫痫发作自由或发作改善）。在9项研究中分析了SRS后AVM癫痫发作改善的相关因素。完全和不完全AVM闭塞的患者分别达到无癫痫状态82％和41.0％。与不完全的AVM闭塞相比，完全的AVM闭塞可提供更高的无发作率（OR 6.13; 95％CI 2.16-17.44; p = 0.0007）。结论立体定向放射外科手术可为癫痫发作的AVM患者提供良好的癫痫预后。完全消除AVM可能会改善癫痫发作控制。
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