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Background <p>Arteriovenous malformations (AVMs) are congenital vascular anomalies characterized by abnormal shunts between arteries and veins, and are an important cause of intracranial hemorrhage in children and young adults. Treatment options include microsurgery, stereotactic radiosurgery (SRS), endovascular embolization, and conservative management. Recent advances in endovascular techniques have positioned embolization as a promising treatment, particularly for deep-seated AVMs. This systematic review and meta-analysis aimed to assess the efficacy and safety of embolization for AVMs located in the basal ganglia and thalamus.</p> Methods <p>This study followed PRISMA guidelines. A comprehensive search of Medline, Embase, and Web of Science was conducted to identify studies reporting outcomes of embolization for basal ganglia or thalamic AVMs. Eligible studies included ≥ 4 patients and reported at least one of the following outcomes: good clinical outcome, AVM occlusion, complications, or mortality. A single-arm meta-analysis using a random-effects model was performed, with proportions reported alongside 95% confidence intervals (CIs). Heterogeneity was assessed using the I² statistic, and Baujat and sensitivity analyses were applied. Risk of bias was evaluated using the ROBINS-I tool.</p> Results <p>Fifteen studies including 227 patients were analyzed. The mean age at diagnosis was 26.1 years, and the gender distribution showed a female-to-male ratio of approximately 1.67:1. Good clinical outcomes were reported in 89% of patients (95% CI: 77%-100%), with a complication rate of 9% (95% CI: 5%-14%) and a mortality rate of 2% (95% CI: 0%-4%). AVM occlusion was achieved in 48% of cases (95% CI: 27%-68%).</p> Conclusion <p>This systematic review and meta-analysis demonstrates that embolization offers good clinical outcomes and acceptable safety in the treatment of AVMs, with low mortality and complication rates, although complete occlusion is achieved only in a subset of patients. The overall occlusion rate remains modest, and combined therapy may be considered in selected cases.</p>

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Effectiveness and safety of embolization for basal ganglia or thalamic arteriovenous malformations: a systematic review and meta-analysis

  • 期刊论文

  • 发表日期：

    2025年10月13日

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  • Filipe Virgilio Ribeiro,
  • Marcelo Porto Sousa,
  • Rudolfh Batista Arend,
  • Bruno Zilli Peroni,
  • Guilherme Cristiano Garcia,
  • José Victor Dantas dos Santos,
  • Christian Ken Fukunaga,
  • Stefeson Gomes Cabral Junior,
  • Leandro Vieira Lessa,
  • Maria Antônia Oliveira Machado Pereira,
  • Anderson Silva Corin,
  • Alex Roman

摘要

Background

Arteriovenous malformations (AVMs) are congenital vascular anomalies characterized by abnormal shunts between arteries and veins, and are an important cause of intracranial hemorrhage in children and young adults. Treatment options include microsurgery, stereotactic radiosurgery (SRS), endovascular embolization, and conservative management. Recent advances in endovascular techniques have positioned embolization as a promising treatment, particularly for deep-seated AVMs. This systematic review and meta-analysis aimed to assess the efficacy and safety of embolization for AVMs located in the basal ganglia and thalamus.

Methods

This study followed PRISMA guidelines. A comprehensive search of Medline, Embase, and Web of Science was conducted to identify studies reporting outcomes of embolization for basal ganglia or thalamic AVMs. Eligible studies included ≥ 4 patients and reported at least one of the following outcomes: good clinical outcome, AVM occlusion, complications, or mortality. A single-arm meta-analysis using a random-effects model was performed, with proportions reported alongside 95% confidence intervals (CIs). Heterogeneity was assessed using the I² statistic, and Baujat and sensitivity analyses were applied. Risk of bias was evaluated using the ROBINS-I tool.

Results

Fifteen studies including 227 patients were analyzed. The mean age at diagnosis was 26.1 years, and the gender distribution showed a female-to-male ratio of approximately 1.67:1. Good clinical outcomes were reported in 89% of patients (95% CI: 77%-100%), with a complication rate of 9% (95% CI: 5%-14%) and a mortality rate of 2% (95% CI: 0%-4%). AVM occlusion was achieved in 48% of cases (95% CI: 27%-68%).

Conclusion

This systematic review and meta-analysis demonstrates that embolization offers good clinical outcomes and acceptable safety in the treatment of AVMs, with low mortality and complication rates, although complete occlusion is achieved only in a subset of patients. The overall occlusion rate remains modest, and combined therapy may be considered in selected cases.