Awake craniotomy in patients with arteriovenous malformation: A systematic review and meta‑analysis

The present systematic review aimed to identify all the available literature on awake craniotomy (AC) in patients with arteriovenous malformation (AVM) in order to evaluate its safety, risks, benefits and effectiveness. All available literature on AC in patients with AVM was collected and evaluated in an aim to provide a better understanding of its safety, associated risks and benefits. A systematic search for studies employing AC in patients with AVM was conducted using the PubMed, Scopus and ScienceDirect databases without restrictions on the year of publication, language, or study design, from inception up to May 30, 2021. A total of 11 studies published between 2004 and 2021 with 106 patients who underwent ACs were considered eligible. The rate of complete resection was 93% [95% confidence interval (CI), 82 to 100%; I² 0%]. The intraoperative complication rate was 21% (95% CI, 1 to 41%; I² 55%) and the post-operative complication rate was 33% (95% CI, 19 to 48%; I² 40%). During follow-up, the complication rate was 6% (95% CI, 1 to 10%; I² 30%). The post-operative complication rate was higher in the Spetzler-Martin grade (SMG) III-V group (31%; 95% CI, 21 to 42%; I² 46%) than in the SMG I-II group (12%; 95% CI, 2 to 22%; I² 0%). Similarly, the follow-up complication rate was higher in the SMG III-V group (9%; 95% CI, 2 to 16%; I² 34%) than in the SMG I-II group (0%; 95% CI, 0 to 4%; I² 0%). On the whole, the present study provides preliminary evidence to indicate that AC is a possible and useful option for the resection of AVM in selected patients. Well-designed future studies with long-term follow-up are required however, to investigate various aspects of safety and provide solid data for AC in patients with AVM.