To assess the safety and efficacy of endovascular embolization (EVE) for treating arteriovenous malformations (AVMs) in the pediatric population.

AVMs are lesions characterized by the presence of arteriovenous shunting. While adult treatments are well-studied, managing AVMs in children remains challenging. 

A systematic search was conducted following PRISMA guidelines, searching three databases: PubMed, Web of Science, and Scopus, up to August 2024. The included studies evaluated the efficacy of EVE compared to other interventions in children with central nervous system AVMs. The primary endpoints were the proportion of patients achieving complete lesion obliteration at 6 months and complication rates. Quality assessment was performed using the Cochrane Risk of Bias 1 tool for nonrandomized studies. A single-arm and random-effects model meta-analysis of proportions was conducted, with the I² statistic used to assess heterogeneity. 

A total of 1,239 studies were screened, of which 20 were included, comprising 492 pediatric patients. EVE was the primary treatment in 173 cases, surgery in 108, radiosurgery in 87, and multimodal treatment in 124 cases. Complete obliteration was achieved in 77 of 173 (44%) patients treated with EVE. Surgery, radiosurgery, and multimodal treatments significantly increased the odds of complete AVM obliteration compared to EVE alone (OR 32.16 [9.99–103.52]; OR 3.67 [1.12–12.04]; and OR 6.12 [1.53–24.49], respectively). The risk of complications for surgery and radiosurgery was comparable to EVE (OR 0.45 [0.14–1.47] and OR 0.67 [0.12–3.69], respectively).

EVE can achieve successful obliteration in approximately half of children with AVMs. However, surgery demonstrated the highest cure rates, with all treatment modalities presenting similar complication profiles. These findings should be individualized, considering the location and grading of the AVMs, that may significantly affect treatment outcomes and risks.