Awake craniotomy in patients with arteriovenous malformation: A systematic review and meta‑analysis

Harikrishna,Arya; Chatzidakis,Stefanos; Ishak,Angela; Faropoulos,Konstantinos; Fotakopoulos,George; Georgakopoulou,Vasiliki Epameinondas; Sklapani,Pagona; Trakas,Nikolaos; Yiallouris,Andreas; Iosif,Christina; Agouridis,Aris P.; Hadjigeorgiou,George

doi:10.3892/mi.2024.166

Awake craniotomy in patients with arteriovenous malformation: A systematic review and meta‑analysis

Authors:
- Arya Harikrishna
- Stefanos Chatzidakis
- Angela Ishak
- Konstantinos Faropoulos
- George Fotakopoulos
- Vasiliki Epameinondas Georgakopoulou
- Pagona Sklapani
- Nikolaos Trakas
- Andreas Yiallouris
- Christina Iosif
- Aris P. Agouridis
- George Hadjigeorgiou
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Affiliations: School of Medicine, European University Cyprus, 2404 Nicosia, Cyprus, Department of Neurosurgery, Nicosia General Hospital, 2031 Nicosia, Cyprus, Department of Neurosurgery, General University Hospital of Larissa, 41221 Larissa, Greece, Department of Pathophysiology, National and Kapodistrian University of Athens, 11527 Athens, Greece, Department of Biochemistry, Sismanogleio Hospital, 15126 Athens, Greece
Published online on: June 6, 2024 https://doi.org/10.3892/mi.2024.166
Article Number: 42
Copyright : © Harikrishna et al. This is an open access article distributed under the terms of Creative Commons Attribution License [CC BY 4.0].

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Abstract

The present systematic review aimed to identify all the available literature on awake craniotomy (AC) in patients with arteriovenous malformation (AVM) in order to evaluate its safety, risks, benefits and effectiveness. All available literature on AC in patients with AVM was collected and evaluated in an aim to provide a better understanding of its safety, associated risks and benefits. A systematic search for studies employing AC in patients with AVM was conducted using the PubMed, Scopus and ScienceDirect databases without restrictions on the year of publication, language, or study design, from inception up to May 30, 2021. A total of 11 studies published between 2004 and 2021 with 106 patients who underwent ACs were considered eligible. The rate of complete resection was 93% [95% confidence interval (CI), 82 to 100%; I² 0%]. The intraoperative complication rate was 21% (95% CI, 1 to 41%; I² 55%) and the post‑operative complication rate was 33% (95% CI, 19 to 48%; I² 40%). During follow‑up, the complication rate was 6% (95% CI, 1 to 10%; I² 30%). The post‑operative complication rate was higher in the Spetzler‑Martin grade (SMG) III‑V group (31%; 95% CI, 21 to 42%; I² 46%) than in the SMG I‑II group (12%; 95% CI, 2 to 22%; I² 0%). Similarly, the follow‑up complication rate was higher in the SMG III‑V group (9%; 95% CI, 2 to 16%; I² 34%) than in the SMG I‑II group (0%; 95% CI, 0 to 4%; I² 0%). On the whole, the present study provides preliminary evidence to indicate that AC is a possible and useful option for the resection of AVM in selected patients. Well‑designed future studies with long‑term follow‑up are required however, to investigate various aspects of safety and provide solid data for AC in patients with AVM.

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