Interventions for treating brain arteriovenous malformations in adults

Area of Science:

• Neurology
• Neurosurgery
• Vascular Surgery

Background:

• Brain arteriovenous malformations (AVMs) are a leading cause of intracerebral hemorrhage in young adults.
• AVMs can also cause seizures and focal neurological deficits, with some discovered incidentally.
• Treatment options include neurosurgical excision, radiosurgery, embolization, and combinations thereof.

Purpose of the Study:

• To evaluate the effectiveness and safety of different brain AVM interventions compared to each other or conservative management.
• To analyze outcomes in adults using randomized controlled trials (RCTs).

Main Methods:

• Searched multiple databases (Cochrane Stroke Group Trials Register, CENTRAL, MEDLINE, Embase) up to January 2019.
• Included one randomized controlled trial (RCT) comparing intervention versus conservative management for unruptured brain AVMs.
• Assessed risk of bias and applied GRADE methodology; moderate-quality evidence was found.

Main Results:

• One RCT (226 participants) showed intervention increased death or dependency (RR 2.53) and symptomatic intracranial hemorrhage (RR 6.75) compared to conservative management.
• No significant difference was observed in the frequency of epileptic seizures between groups.
• Moderate-quality evidence suggests conservative management is superior for functional outcome and hemorrhage prevention in the short term.

Conclusions:

• Conservative management demonstrated superiority over intervention for unruptured brain AVMs regarding functional outcomes and symptomatic intracranial hemorrhage within one year.
• Further RCTs are necessary to validate these findings and guide optimal treatment strategies for brain AVMs.