Preoperative embolisation of brain arteriovenous malformations: a systematic review and meta-analysis

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Abstract

Preoperative embolisation is a commonly performed adjunct to microsurgical excision of brain arteriovenous malformations (bAVMs), with aims such as lessening the technical difficulty of the microsurgical procedure, reducing operative time, decreasing blood loss, and improving patient functional outcomes. We aim to perform a systematic review of randomised trials and cohort studies evaluating preoperative embolisation of bAVMs published between 01 January 2000 and 31 March 2021 and appraise its role in clinical practice. A MEDLINE search was performed, and articles reporting on outcomes following preoperative embolisation, as an adjunct to microsurgery, were eligible for inclusion. PRISMA reporting and Cochrane Handbook guidelines were followed. The primary outcome measure was the risk of complications associated with preoperative embolisation. The study was registered with PROSPERO (CRD42021244231). Of the 1661 citations, 8 studies with 588 patients met predefined inclusion criteria. No studies specifically compared outcomes of surgical excision of bAVMs between those with and without preoperative embolisation. Spetzler Martin (SM) grading was available in 301 cases. 123 of 298 (41⋅28%) patients presented with haemorrhage. Complications related to embolisation occurred in 175/588 patients (29.4%, 95% CI 19.6–40.2). Permanent neurological deficits occurred in 36/541 (6%, 95% CI 3.9–8.5) and mortality in 6/588 (0.41%, 95% CI 0–1.4). This is the first systematic review evaluating preoperative embolisation of bAVMs. Existing studies assessing this intervention are of poor quality. Associated complication rates are significant. Based on published literature, there is currently insufficient evidence to recommend preoperative embolisation of AVMs. Further studies are required to ascertain if there are benefits of this procedure and if so, in which cases.

Supplementary Information

The online version contains supplementary material available at 10.1007/s10143-022-01766-8.

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The PRISMA statement for reporting systematic reviews and meta-analyses of studies that evaluate health care interventions: explanation and elaboration.

Alessandro Liberati, Douglas G. Altman, Jennifer Tetzlaff … (2009)

Systematic reviews and meta-analyses are essential to summarize evidence relating to efficacy and safety of health care interventions accurately and reliably. The clarity and transparency of these reports, however, is not optimal. Poor reporting of systematic reviews diminishes their value to clinicians, policy makers, and other users. Since the development of the QUOROM (QUality Of Reporting Of Meta-analysis) Statement--a reporting guideline published in 1999--there have been several conceptual, methodological, and practical advances regarding the conduct and reporting of systematic reviews and meta-analyses. Also, reviews of published systematic reviews have found that key information about these studies is often poorly reported. Realizing these issues, an international group that included experienced authors and methodologists developed PRISMA (Preferred Reporting Items for Systematic reviews and Meta-Analyses) as an evolution of the original QUOROM guideline for systematic reviews and meta-analyses of evaluations of health care interventions. The PRISMA Statement consists of a 27-item checklist and a four-phase flow diagram. The checklist includes items deemed essential for transparent reporting of a systematic review. In this Explanation and Elaboration document, we explain the meaning and rationale for each checklist item. For each item, we include an example of good reporting and, where possible, references to relevant empirical studies and methodological literature. The PRISMA Statement, this document, and the associated Web site (http://www.prisma-statement.org/) should be helpful resources to improve reporting of systematic reviews and meta-analyses.

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Author and article information

Contributors

Conor Brosnan:

ORCID: http://orcid.org/0000-0002-6902-5164

conorbrosnan@rcsi.ie

Journal

Journal ID (nlm-ta): Neurosurg Rev

Journal ID (iso-abbrev): Neurosurg Rev

Title: Neurosurgical Review

Publisher: Springer Berlin Heidelberg (Berlin/Heidelberg )

ISSN (Print): 0344-5607

ISSN (Electronic): 1437-2320

Publication date (Electronic): 9 March 2022

Publication date PMC-release: 9 March 2022

Publication date (Print): 2022

Volume: 45

Issue: 3

Pages: 2051-2063

Affiliations

[1 ]GRID grid.414315.6, ISNI 0000 0004 0617 6058, National Neurosurgical Centre, Beaumont Hospital, ; Dublin 9, D09 V2N0 Ireland

[2 ]GRID grid.4912.e, ISNI 0000 0004 0488 7120, Royal College of Surgeons in Ireland, ; Dublin 2, Ireland

[3 ]GRID grid.8217.c, ISNI 0000 0004 1936 9705, Trinity College Dublin, ; Dublin 2, Ireland

Author information

Conor Brosnan http://orcid.org/0000-0002-6902-5164

Michael Amoo http://orcid.org/0000-0001-6886-6714

Mohsen Javadpour http://orcid.org/0000-0001-9836-1741

Article

Publisher ID: 1766

DOI: 10.1007/s10143-022-01766-8

PMC ID: 9160113

PubMed ID: 35260972

SO-VID: 3355c5a8-631d-412c-8907-db31e4c51a21

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Open AccessThis article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/.

History

Date received : 1 January 2022

Date revision received : 26 February 2022

Date accepted : 1 March 2022

Funding

Funded by: Royal College of Surgeons in Ireland (RCSI)

Open Access :

Open Access funding provided by the IReL Consortium

Custom metadata

ScienceOpen disciplines: Surgery

Keywords: embolisation,arteriovenous malformation,brain,cerebral,surgery,preoperative

Data availability:

ScienceOpen disciplines: Surgery

Keywords: embolisation, arteriovenous malformation, brain, cerebral, surgery, preoperative

Preoperative embolisation of brain arteriovenous malformations: a systematic review and meta-analysis

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Most cited references 26

Conducting Meta-Analyses inRwith themetaforPackage

The PRISMA statement for reporting systematic reviews and meta-analyses of studies that evaluate health care interventions: explanation and elaboration.

How to perform a meta-analysis with R: a practical tutorial

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