Stereotactic radiosurgery (SRS) is a non-invasive treatment option for brain arteriovenous malformations (bAVMs). However, SRS cures are delayed, making it less favorable for higher risk ruptured bAVMs (rbAVMs) than unruptured (ubAVMs). This systematic review and meta-analysis explores the long-term outcomes of SRS-focused protocols for rbAVMs and ubAVMs. This study adhered to the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analysis) guidelines. Literature search was conducted using PubMed, Ovid Medline, Scopus, and hand-search on January 30th, 2025. The inclusion criteria encompassed studies: distinguishing cohorts by rupture status, reporting post-SRS outcomes, and without overlapping series. Pooled analysis was performed from 24 articles using DerSimonian-Laird random effects models. Subgroup and meta-regression analyses were also conducted. All analyses were performed using R. For rbAVMs, the pooled rupture, obliteration, and mortality rates were 7.14% (95% CI: 5.76%-8.64%), 65.0% (95% CI: 57.2%-72.4%), and 0.87% (95% CI: 0.00%-5.14%), respectively, and for ubAVMs, 6.13% (95% CI: 4.71%-7.69%), 59.5% (95% CI: 51.3%-67.3%), and 0.89% (95% CI: 0.00%-3.82%), respectively. Subgroup meta-analyses of rupture rates and obliteration rates showed no significant differences based on prior treatments (Q = 2.47, p = 0.48
Q = 4.34, p = 0.23
respectively) or volume-staging protocols (Q = 4.90, p = 0.18
Q = 1.12, p = 0.77, respectively). Meta-regression analysis for rbAVMs demonstrated a positive correlation between intranidal aneurysms and rupture rate (p <
0.05, R