Interventions for treating brain arteriovenous malformations in adults

Area of Science:

• Neurology
• Neurosurgery
• Interventional Radiology

Background:

• Brain arteriovenous malformations (AVMs) are a leading cause of intracerebral hemorrhage in young adults.
• AVMs can also cause seizures and neurological deficits, or be found incidentally.
• Interventions include neurosurgical excision, stereotactic radiotherapy, and endovascular embolization.

Purpose of the Study:

• To evaluate the clinical effectiveness of treatments for adult brain AVMs.
• The review focuses on data from randomized controlled trials (RCTs).
• Aims include assessing partial obliteration and total eradication of AVMs.

Main Methods:

• Searched multiple databases (Cochrane Stroke Group, CENTRAL, MEDLINE, EMBASE) up to November 2009.
• Included RCTs comparing AVM interventions against each other or medical therapy.
• Contacted manufacturers for information on interventional treatments.

Main Results:

• One ongoing RCT (ARUBA) compares intervention versus medical management for unruptured AVMs.
• Two RCTs on embolic agents for pre-operative embolization did not meet outcome criteria.
• A third RCT on blood pressure management during surgery was excluded.

Conclusions:

• Currently, no RCT evidence guides the choice of intervention for adult brain AVMs.
• There is a lack of comparative data for different interventional treatments or against medical therapy.
• The ongoing ARUBA trial is expected to provide crucial evidence.