Treatments of unruptured brain arteriovenous malformations

Abstract

Background: The best therapeutic option for unruptured brain arteriovenous malformations (bAVMs) patients is disputed. Objective: To assess the occurrence of obliteration and complications of patients with unruptured bAVMs after various treatments. Methods: A systematic literature search was performed in PubMed, EMBASE, Web of Science, and so on to identify studies fulfilling predefined inclusion criteria. Baseline, treatment, and outcomes data were extracted for statistical analysis. Results: We identified 28 eligible studies totaling 5852 patients. The obliteration rates were 98% in microsurgery group (95% confidence interval (CI): 96%–99%, I 2 = 74.5%), 97% in surgery group (95%CI: 95%–99%, I 2 = 18.3%), 87% in endovascular treatment group (95%CI: 80%–93%, I 2 = 0.0%), and 68% in radiosurgery group (95%CI: 66%–69%, I 2 = 92.0%). The stroke or death rates were 1% in microsurgery group (95%CI: 0%–2%, I 2 = 0.0%), 0% in surgery group (95%CI: 0%–1%, I 2 = 0.0%), 4% in endovascular treatment group (95%CI: 0%–8%, I 2 = 85.8%), and 3% in radiosurgery group (95%CI: 3%–4%, I 2 = 82.9%). In addition, the proportions of hemorrhage were 2% in microsurgery group (95%CI: 1%–4%, I 2 = 0.0%), 23% in endovascular treatment group (95%CI: 7%–39%), and 12% in radiosurgery group (95%CI: 12%–13%, I 2 = 99.2%). As to neurological deficit, the occurrence was 9% in microsurgery group (95%CI: 6%–11%, I 2 = 94.1%), 20% in surgery group (95%CI: 13%–27%, I 2 = 0.0%), 14% in endovascular treatment group (95%CI: 10%–18%, I 2 = 64.0%), and 8% in radiosurgery group (95%CI: 7%–9%, I 2 = 66.6%). Conclusions: We found that microsurgery might provide lasting clinical benefits in some unruptured bAVMs patients for its high obliteration rates and low hemorrhage. These findings are helpful to provide a reference basis for neurosurgeons to choose the treatment of patients with unruptured bAVMs.

Microsurgery versus Microsurgery With Preoperative Embolization for Brain Arteriovenous Malformation Treatment: A Systematic Review and Meta-analysis

“…The consensus is that patients with high-risk features should undergo treatment if the risk profile is favorable. 9,21,22 Surgery is an option when the risk is acceptable. 23,24 Continued effort to advance surgical techniques has been made to increase safety and effectiveness in achieving obliteration.…”

“…Preoperative embolization has been a long-standing surgical adjunct with presumed advantage in mitigating high-risk features, reducing bleeding, and delineating lesion margin. 9,21,22,25 However, embolization risks include periprocedural bleeding, resulting in overall 16% morbidity, 2% to 4% mortality, and new neurological deficits up to 14%. 12,26 Therefore, physicians should meticulously weigh the risk and benefit of preoperative embolization.…”

“…The consensus is that patients with high-risk features should undergo treatment if the risk profile is favorable. 9,21,22…”

Untangling the Modern Treatment Paradigm for Unruptured Brain Arteriovenous Malformations

“…When each treatment modality is analyzed individually, Liu et al in a review of 28 studies with an aggregate 5852 patients demonstrated obliteration rates of 98% for microsurgery, 87% for embolization, and 68% for SRS. They also reported complications of 1% stroke or death for microsurgery, 4% for embolization, and 8% for SRS [ 21 ].…”

Angiographic predictors of spontaneous obliteration of transarterial partially embolized brain arteriovenous malformations

“…Microsurgery plays a major role in the immediate eradication with a good result in low-grade lesions, but it carries a high rate of morbidity in the high-grade ones. 1 Radiosurgery can be used in many lesions with a success rate. 2 it can be used alone or after surgery or after partial embolization.…”