Introduction: Intramedullary arteriovenous malformations (AVMs) are complex vascular lesions within the spinal cord, presenting significant diagnostic and therapeutic challenges. Clinical manifestations vary widely, from incidental findings to progressive neurological deficits. This systematic review aims to analyze global trends in the presentation, imaging, and management outcomes of intramedullary AVMs, emphasizing therapeutic efficacy and complication rates.
Methods: A systematic search identified studies across multiple countries, including case series and observational reports. Data extraction covered patient demographics, AVM type and location, treatment modalities, and clinical outcomes. Meta-analytical models calculated pooled proportions for complete obliteration, clinical improvement, complications, and partial reductions in AVM size.
Results: A total of 99 patients from Germany, Canada, Latvia, the United States, and Italy were analyzed. Patient age ranged widely, with a mean age of 32 years. The pooled estimate for complete obliteration of AVMs post-treatment was 36% (95% CI: 20-55%), indicating moderate success in total AVM closure. Clinical improvements were seen in 49% of patients (95% CI: 14-85%), though high heterogeneity (I² = 87%) reflects variability in treatment response. Complications occurred in 32% of cases (95% CI: 17-52%), including transient neurological deficits and surgical complications as cerebrospinal fluid leakage and venous thrombosis. Partial reductions in AVM size were reported in 52% of patients (95% CI: 19-83%), showing symptom relief in some cases without total AVM obliteration.
Conclusion : Treatment of intramedullary AVMs achieves moderate success in obliteration and clinical improvement rates but is associated with significant risks. The high variability in patient outcomes suggests a need for individualized treatment strategies. This analysis highlights the importance of tailoring therapies based on AVM characteristics and patient presentation to minimize complications and improve long-term outcomes. Further research should focus on identifying predictors of successful outcomes and on standardizing treatment protocols to enhance patient prognosis worldwide.
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