• PinheiroLeon Cleres PenidoLCPDivision of Neurosurgery, São Paulo University, Sao Paulo, Brazil. Electronic address: Leoncppinheiro@gmail.com., Wolak JuniorMarioMDivision of Neurosurgery, São Paulo State University, Botucatu, Brazil., Marcio Yuri Ferreira, Raphael Bertani Magalhaes, Adriano Yacubian Fernandes, Wellingson Silva Paiva, Marco Antonio Zanini, and Marchesan RodriguesMaria AparecidaMADepartment of Pathology, São Paulo State University, Botucatu, Brazil..
• Division of Neurosurgery, São Paulo University, Sao Paulo, Brazil. Electronic address: Leoncppinheiro@gmail.com.
• World Neurosurg. 2024 May 1; 185: 381392.e1381-392.e1.

BackgroundTreating unruptured brain arteriovenous malformations (bAVMs) represent significant challenges, with numerous uncertainties still in debate. The ARUBA trial induced further investigation into optimal management strategies for these lesions. Here, we present a systematic-review and meta-analysis focusing on ARUBA-eligible studies, aiming to correlate patient data with outcomes and discuss key aspects of these studies.MethodsFollowing PRISMA guidelines, we conducted a systematic-review. Variables analyzed included bAVM Spetzler-Martin (SM) grade, treatment modalities, and outcomes such as mortality and neurological deficits. We compared studies with a minimum of 50% cases classified as SM 1-2 lesions and those with less than 50% in this category. Similarly, a comparison between studies with at least 50% microsurgery-cases and those with less than 50% was performed. We examined correlations between mortality incidence, SM distribution, and treatment modalities.ResultsOur analysis included 16 studies with 2.417 patients. The frequency of bAVMs SM-grade 1-2 ranged from 44% to 76%, SM-grade 3 from 19% to 48%, and SM 4-5 from 5 to 23%. Notably, studies with more than 50% cases presenting lesions SM-grade 1-2 presented significantly lower mortality rates than those with less than 50% cases of SM 1-2 lesions (P < 0.001). No significant difference in mortality rates or neurological deficits was identified between studies with more than 50% of microsurgery-cases and those with less than 50%.ConclusionsThe analysis revealed that studies with a higher proportion of bAVMs presenting SM 1-2 lesions were associated with lower mortality rates. Mortality did not show a significant association with treatment modalities.Copyright © 2024 Elsevier Inc. All rights reserved.

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