ReviewBrain & spine2026
Outcomes of Microsurgical, Endovascular, Multimodal, and Radiosurgical Management of Spinal Intramedullary Arteriovenous Malformations: A Systematic Review and Exploratory Meta-Analysis.
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.
What it found
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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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Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
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Who cites it
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Authors and funding
8 authors.
Funding
No grant is acknowledged in the PubMed record.
Abstract
Introduction: Spinal intramedullary arteriovenous malformations (Si-AVMs) are rare lesions determined by angioarchitecture, location, clinical presentation, and procedural intent, making comparisons between modalities vulnerable to confounding by indication. Research question: To characterize radiographic, functional, and safety outcomes after microsurgical, endovascular, combined, and radiosurgical management of Takai Type II/III Si-AVMs while distinguishing complete treatment, planned partial embolization, residual disease, recanalization, and multimodality care. Materials and methods: A PRISMA-guided systematic review and exploratory meta-analysis of studies published from 2000 to 2024 included seven retrospective studies comprising up to 672 Type II/III or nidus-type lesions. Treatment pathways and embolization intent were analyzed separately. Combined-treatment patients were retained as a distinct group unless outcomes were disaggregated. Because outcome definitions were heterogeneous, pooled estimates were considered descriptive and hypothesis-generating. Results: Microsurgical series generally reported higher complete angiographic obliteration than embolization-only series; however, lesion selection and planned multimodality treatment precluded causal comparison. In the largest cohort, 68/258 (26.4%) embolization-only patients achieved complete obliteration. Recanalization occurred in 15/30 (50.0%) lesions initially considered completely obliterated and in 73/219 (33.3%) embolized lesions. After partial embolization, lesion proliferation and de novo aneurysm formation each occurred in 22/191 (11.5%) patients. Permanent neurological deterioration occurred more often after microsurgery than embolization (16.1% vs. 5.6%). Discussion and conclusion: The available evidence supports lesion-specific, complementary use of microsurgery, embolization, combined treatment, and radiosurgery rather than modality-wide superiority. Microsurgery may provide durable obliteration in selected lesions, whereas embolization may be curative, staged, neoadjuvant, or palliative. Radiosurgery remains a niche option for selected, inaccessible lesions. All conclusions are hypothesis-generating.
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