The Effectiveness of Different Treatment Modalities for Brain Arteriovenous Malformations in Providing a Seizure-Free and Neurological Deficit Free Outcome in Adult Patients: A Systematic Review

An arteriovenous brain malformation is a disorder where there is a tangle of abnormal blood vessels that connect arteries and veins. Proper functioning of blood vessels is vital to the brain's oxygenation but with a brain arteriovenous malformation  that disrupts oxygenating the brain. Arteriovenous malformations can occur anywhere, but they most commonly occur in the brain and spine. Once diagnosed, surgical treatment options are available to control and stop the disease, such as surgical resection, endovascular embolization, and stereotactic radiosurgery. The objective of this article is to determine the effectiveness of different treatment modalities for brain arteriovenous malformations in providing a seizure-free and neurological deficit free outcome in adult patients. An extensive literature search was conducted using PubMed and PubMed central as our main databases. The articles exploring the association and success rate between different treatment modalities and seizure and neurological-free outcomes were included. A total of 2066 studies were obtained by searching the databases, and after thorough screening, 29 studies were included for the review. This review highlights that microsurgery provides the best seizure control; however, if complete obliteration is achieved with stereotactic radiosurgery, then that offers the best control, and that is something that needs further investigation as there aren't as many studies on it. Moreover, we concluded that further investigations should be done on the combination therapy comprising embolization and stereotactic radiosurgery. It has great potential to provide a large percentage of the patients with this condition to achieve a seizure-free status.