Interventions for treating brain arteriovenous malformations in adults

Area of Science:

• Neurology
• Neurosurgery
• Vascular Medicine

Background:

• Brain arteriovenous malformations (AVMs) are a leading cause of intracerebral hemorrhage in young adults.
• AVMs can also cause seizures and neurological deficits, with some cases discovered incidentally.
• Current treatments include neurosurgical excision, stereotactic radiotherapy, endovascular embolization, and combined approaches.

Purpose of the Study:

• To evaluate the clinical effectiveness of interventions for treating brain AVMs in adults.
• The review aimed to analyze data from randomized controlled trials (RCTs) for partial obliteration or total eradication of AVMs.

Main Methods:

• A comprehensive search of multiple databases (Cochrane Stroke Group Register, MEDLINE, EMBASE, CENTRAL) was conducted up to December 2004/early 2005.
• Searches included on-line and paper journals, international clinical trial registers, and bibliographies of relevant articles.
• The review sought RCTs comparing AVM interventions against each other or against usual medical therapy, using relevant clinical outcomes.

Main Results:

• No randomized trials meeting the inclusion criteria were found.
• Two RCTs on embolic agents for pre-operative embolization were identified but lacked suitable outcome measures for comparison.
• A third RCT on blood pressure management during surgery was excluded as it did not focus on AVM intervention comparison.

Conclusions:

• There is a lack of evidence from RCTs to guide the interventional treatment of adult brain AVMs.
• Current evidence does not support comparisons between different interventions or against medical therapy.
• A planned trial (ARUBA) will compare interventional versus conservative management for unruptured brain AVMs.