Turkish Neurosurgery
Transvenous Embolization of Brain Arteriovenous Malformations: Up-to-Date Meta-Analysis
Mohamed Deniwar1, wessam Mustafa2, Hossam Elfeki3, Ashraf Ezz Eldin1, Basem I. Awad1
1Mansoura University , neurosurgery, Mansoura,
2Mansoura University , neurology, Mansoura,
3Mansoura University , surgery, Mansoura,
DOI: 10.5137/1019-5149.JTN.36461-21.2

Introduction: Brain arteriovenous malformations (BAVMs) remain challenging to treat. Despite recent advancements in endovascular modalities, transarterial embolization (TAE) can be significantly challenging to perform on some arteriovenous malformations (AVMs) given their plexiform nature, distant location of the nidus, and the presence of small tortuous arterial feeders to access. As such, transvenous embolization (TVE) of Brain AVMs (BAVMs) has emerged as a potential novel therapy in the past few years with promising results. Objective: We conducted an up-to-date meta-analysis to assess the success and complication rates of TVE and determine its efficacy and safety. Methodology: Relevant and potentially relevant studies from 1982 to February 2021 were searched; after which those that satisfied our eligibility criteria and reported the main outcomes (endovascular occlusion and complication rates) were included. Results: Ultimately seven studies were selected. In total, 154 patients were comprehensively reviewed for BAVMs characteristics and endovascular TVE techniques. The weighted mean rate of immediate endovascular total occlusion, overall technical complication, and overall good functional outcome (mRs < 2) were 93% (95% confidence intervals (CI), 89.1%–96.9%, I2 = 0%, P = 0.487), 10.5% (95% CI, 4.3%–16.6%, I2 = 30.8%, P = 0.193), and 90.9% (95% CI, 85.3%–96.6%, I2 = 26.6%, P = 0.241), respectively. Conclusions: TVE for BAVMs was found to be generally safe and effective in certain selected patients. However, the complementary role of TAE to TVE as a definitive endovascular treatment for BAVMs cannot be separated. More studies regarding this role need to be conducted.

Corresponding author : Mohamed Deniwar