Thalamic Arteriovenous Malformations: A Systematic Review of Presentation, Diagnostic Modalities, and Treatment Approaches.

Thalamic arteriovenous malformations (AVMs) are rare, deep-seated vascular lesions associated with a high risk of hemorrhage and significant neurological deficits. Due to their complex anatomy, these lesions present unique challenges in management. Various therapeutic approaches, including microsurgical resection, stereotactic radiosurgery, and embolization, have been employed to address these challenges. This systematic review examines the clinical presentation, diagnostic modalities, treatment outcomes, and complications associated with thalamic AVMs. A comprehensive literature search was conducted in PubMed, Scopus, and Rayyan databases, focusing on studies reporting clinical outcomes of patients with thalamic AVMs. Eligible studies included those assessing treatment outcomes for surgical resection, stereotactic radiosurgery (SRS), and embolization. Data extraction and risk of bias assessments were performed in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Nineteen studies, comprising a total of 97 patients, were included. Radiosurgery was the most frequently employed treatment, with obliteration rates ranging from 66.7% to 82%, though it carried a risk of post-treatment complications such as rebleeding (5.9%) and neurological deficits (17%). Microsurgery achieved obliteration rates of up to 71%, but this was associated with significant perioperative risks. In comparison, radiosurgery demonstrated obliteration rates ranging from 66.7% to 82%, offering a balance between safety and efficacy for most patients. Embolization, though less commonly used, showed promise in select cases, while conservative management was effective for patients in whom surgery posed an excessive risk. The management of thalamic AVMs is multidisciplinary, with treatment decisions tailored to individual AVM characteristics, patient status, and risk profiles over time. Microsurgical resection remains an option for cases requiring immediate intervention.