Surgical management outcomes of intracranial arteriovenous malformations after preoperative embolization: a systematic review and meta-analysis

Authors

Marian T. Park, Department of Neurosurgery, Neuroscience Publications, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, 350 W Thomas Rd., Phoenix, AZ, 85013, USA.
Muhammed Amir Essibayi, Department of Neurosurgery, Neuroscience Publications, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, 350 W Thomas Rd., Phoenix, AZ, 85013, USA.
Visish M. Srinivasan, Department of Neurosurgery, Neuroscience Publications, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, 350 W Thomas Rd., Phoenix, AZ, 85013, USA.
Joshua S. Catapano, Department of Neurosurgery, Neuroscience Publications, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, 350 W Thomas Rd., Phoenix, AZ, 85013, USA.Follow
Christopher S. Graffeo, Department of Neurosurgery, Neuroscience Publications, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, 350 W Thomas Rd., Phoenix, AZ, 85013, USA.Follow
Michael T. Lawton, Department of Neurosurgery, Neuroscience Publications, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, 350 W Thomas Rd., Phoenix, AZ, 85013, USA. Neuropub@barrowneuro.org.Follow

Document Type

Article

Abstract

OBJECTIVE: Preoperative embolization for brain arteriovenous malformations (AVMs) has been shown to mitigate morbidity for high-risk AVMs, chiefly by reducing lesional blood flow before resection. However, associated risks include postembolization AVM rupture, and the effect of preoperative embolization on outcome remains uncertain. We performed a meta-analysis of the literature on preoperative embolization for microsurgically treated AVMs. METHODS: A systematic review and meta-analysis were conducted of all English-language publications reporting clinical outcomes after combined embolization and surgical resection for AVMs. Single- and 2-arm analyses were performed using random-effects modeling. RESULTS: Thirty-six studies with 2108 patients were included in this analysis. Most patients (90.6%) who underwent embolization had at least a 50% obliteration of AVMs on posttreatment preoperative angiography, with a mean rate of obliteration of approximately 80% (range 28.8-100%). Among patients who had combined treatment, 3.4% (95% confidence interval [CI] 2.1-4.6%) experienced embolization-related hemorrhagic complications before surgery. Both treatment groups achieved excellent postsurgical complete resection rates (odds ratio [OR] 1.05; 95% CI 0.60-1.85). Neither the clinical outcome (OR 1.42; 95% CI 0.84-2.40) nor the total number of hemorrhagic complications (OR 1.84; 95% CI 0.88-3.85) was significantly different between the treatment groups. CONCLUSIONS: In this meta-analysis, preoperative embolization appears to have substantially reduced the lesional volume with active AV shunting before AVM resection. Anecdotally, preoperative embolization facilitates safe and efficient resection; however, differences in outcomes were not significant. The decision to pursue preoperative embolization remains a nuanced decision based on individual lesion anatomy and treatment team experience.

Medical Subject Headings

Humans; Treatment Outcome; Retrospective Studies; Intracranial Arteriovenous Malformations (surgery); Embolization, Therapeutic; Neurosurgical Procedures; Radiosurgery

Publication Date

12-1-2022

Publication Title

Neurosurgical review

E-ISSN

1437-2320

Volume

45

Issue

6

First Page

3499

Last Page

3510

PubMed ID

36168072

Digital Object Identifier (DOI)

10.1007/s10143-022-01860-x

Recommended Citation

Park, Marian T.; Essibayi, Muhammed Amir; Srinivasan, Visish M.; Catapano, Joshua S.; Graffeo, Christopher S.; and Lawton, Michael T., "Surgical management outcomes of intracranial arteriovenous malformations after preoperative embolization: a systematic review and meta-analysis" (2022). Neurosurgery. 1842.
https://scholar.barrowneuro.org/neurosurgery/1842