Microsurgical approach versus endovascular treatment of craniocervical junction arteriovenous fistulas: A Systematic Review and Meta-analysis.

[INTRODUCTION] Craniocervical junction arteriovenous fistulas (CCJ AVFs) are rare and complex vascular lesions that pose significant diagnostic and therapeutic challenges. Despite advances in neuroimaging, optimal treatment strategies remain controversial. This systematic review and meta-analysis aimed to compare the safety and efficacy of microsurgical versus endovascular approaches for treating CCJ AVFs.

[METHODS] A systematic search of PubMed, Embase, Web of Science, and Cochrane Library was conducted up to March 2024. Studies were included if they reported outcomes of microsurgical or endovascular treatment for CCJ AVFs, including neurological improvement, complete obliteration, recurrence, and complications. Data were synthesized using a random-effects meta-analysis, and heterogeneity was assessed using the I² statistic.

[RESULTS] Seven studies with 451 patients were included (microsurgery: n = 348; endovascular: n = 103). Microsurgery showed no statistically significant advantage in neurological improvement compared to endovascular treatment (OR = 2.10, 95% CI: 0.83-5.31, p = 0.5651, I² = 0%). Complete obliteration rates were significantly higher in the microsurgical group (OR = 11.93, 95% CI = 2.12-66.97, p = 0.0049; I² = 70.6%). Recurrence rates did not differ significantly (OR = 0.22, 95% CI: 0.02-2.81, p = 0.2416). Overall complications were similar (OR = 0.63, 95% CI: 0.09-4.62, p = 0.0007, I² = 79.1%), although microsurgery had significantly fewer ischemic complications (OR = 0.23, 95% CI: 0.07-0.70, p = 0.0104). Mortality rates were also comparable (RR = 1.87, 95% CI: 0.28-12.66, p = 0.5213, I² = 25.9%).

[CONCLUSION] Microsurgery offers higher obliteration rates and fewer ischemic complications, while overall outcomes support individualized treatment planning.