Introduction: Arteriovenous malformations (AVMs) commonly cause seizures. The object of this meta-analysis was to determine if the treatment modality for AVMs affects the rate of becoming seizure-free.
Methods: All published data that described seizure outcomes either primarily or as a secondary goal over the last 20 years were included in this study. The rates of becoming seizure-free following microsurgery (MS), endovascular embolization for cure (EVE), or radiosurgery (SRS) were compared.
Results: Twenty-four studies, with at total of 1157 patients, met the criteria for inclusion. The microsurgical and radiosurgery groups had significantly better seizure control than the endovascular embolization group (p < 0.001), with the relative rates as follows: MS (73%), SRS (62.9%), and EVE (50%). Further analysis revealed that for patients in the SRS group who had complete obliteration of the AVM, seizure-free control improved to 83.3%.
Conclusions: This is the first meta-analysis designed to address the relative rates of seizure-free status following the three commonly utilized treatment modalities for AVMs. The treatment modality that cures the AVM is best correlated with being seizure-free. Microsurgery has the highest rate of achieving this desired outcome initially; however, in patients cured via SRS, rates of seizure-free status were the highest.
Patient Care: Our findings highlight the need for randomized controlled trials to assess the seizure-cure rates achieved by microsurgery, stereotactic radiosurgery, and endovascular embolization. Our results lay the framework for future guidelines that will provide evidence-based rationale for the treatment of AVMs that have seizures as part of their pathologic sequelae.
Learning Objectives: By the conclusion of this session, participants should be able to:
1.) Describe the importance of seizure-control as a outcome measure for assessing the success of AVM intervention.
2.) Discuss the seizure outcomes achieved by microsurgery, stereotactic radiosurgery, and endovascular embolization for cerebral AVMs.
3.) Discuss in small groups the pros and cons to using each of the treatment modalities and discuss the need for randomized controlled trials to provide guidelines for treatment of cerebral AVMs.