Treatments of unruptured brain arteriovenous malformations: A systematic review and meta-analysis

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.