ReviewBrain & spine2026
A systematic review and meta-analysis of microsurgery and radiosurgery outcomes in low-grade cerebral arteriovenous malformations: Obliteration rates, morbidity, and mortality.
Review in Brain & spine, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
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7 authors.
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Abstract
Introduction: Low-grade cerebral arteriovenous malformations (LGCAVMs) are treated with microsurgery according to Spetzler-Martin (SM) grade. Radiosurgery is an emerging treatment for LGCAVMs. Existing comparative evidence is mostly from retrospective, non-randomized cohorts, limiting direct comparison between treatments. Research question: This study compared the outcomes of microsurgery and radiosurgery for LGCAVMs.Material and Methods: This systematic review and meta-analysis followed PRISMA guidelines. Article search was conducted until December 13, 2023, in PubMed, Scopus, Cochrane Library, and Google Scholar. Articles on the outcomes of SM I-II CAVMs treated with radiosurgery and microsurgery were included. Methodological quality assessment was conducted using the Newcastle-Ottawa Scale. Results: This review of 22 studies involving 3259 LGCAVM cases found microsurgery (56.1%) had 93.5% cumulative complete obliteration rate and 1.8% post-treatment haemorrhage compared to 77.2% and 6.6%, respectively, in radiosurgery group (43.9%). Obliteration after radiosurgery was observed after two years. Meta-analysis of five studies comparing both treatments showed that microsurgery yielded higher risk ratio (RR) for complete obliteration of 1.62 [95% CI 1.33, 1.97] but higher RR for morbidity of 10.26 (95% CI 2.99; 35.25). Radiosurgery is beneficial for SM grade II AVMs when microsurgery is risky. Discussion and conclusion: Microsurgery remains associated with higher immediate complete obliteration for LGCAVMs. For selected SM grade II CAVMs (deep-seated, deep drainage, or eloquent areas), radiosurgery is an important alternative when microsurgical risk is high, with complete obliteration observed at two years of follow-up. Given the retrospective, non-randomized evidence, and treatment-selection bias, these findings should be regarded as hypothesis-generating rather than definitive.
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