The use of Bevacizumab in the treatment of brain arteriovenous malformations: a systematic review.

Abstract

Brain arteriovenous malformations (bAVMs) are high-flow vascular anomalies associated with a significant risk of intracranial haemorrhage, particularly in young individuals. Standard treatments-including microsurgery, stereotactic radiosurgery (SRS), and endovascular embolization-are not feasible for all patients, especially those with high-grade or surgically inaccessible lesions. Bevacizumab, a monoclonal antibody targeting vascular endothelial growth factor (VEGF), has emerged as a potential medical therapy aimed at modulating angiogenesis and managing post-treatment complications. This systematic review was conducted according to PRISMA guidelines and registered with PROSPERO (CRD42024563735). A comprehensive search of PubMed, Embase, and Medline was performed up to March 2024, using terms related to Bevacizumab and brain AVMs. Studies were included if they involved adult patients with intracranial AVMs and were published in English. Two reviewers independently screened and extracted data, and quality was assessed using NIH tools.Twelve studies met inclusion criteria, comprising pilot trials, case series, and case reports. One study investigated Bevacizumab as a standalone treatment for inoperable bAVMs, demonstrating safety but no reduction in nidus volume. The remaining studies assessed Bevacizumab in the management of radiation-induced complications-including necrosis and steroid-resistant oedema-following SRS. Across these, Bevacizumab was consistently associated with clinical and radiological improvements and had a favourable safety profile, though most studies were limited by small sample sizes and lack of control groups. There is insufficient evidence to support Bevacizumab as a first-line treatment for bAVMs. However, early data suggest it may play a valuable adjunctive role in managing post-SRS complications. Future research should include larger, controlled studies with diverse patient populations, varied dosing regimens, and long-term follow-up to better define its therapeutic potential and positioning within the bAVM treatment paradigm.