ABSTRACT BACKGROUND: Embolization is a promising treatment strategy for cerebral arteriovenous malformations (AVMs). However, consensus regarding the main complications or long-term outcomes of embolization in AVMs remains lacking. OBJECTIVE: To characterize the most prevalent complications and long-term outcomes in patients with AVM undergoing therapeutic embolization. DESIGN AND SETTING: This systematic review was conducted at the Federal University of Alagoas, Arapiraca, Brazil. METHODS: This systematic review was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses criteria. Data were obtained from MEDLINE, PubMed, LILACS, and SciELO databases, which included the epidemiological profile of the population, characteristics of the proposed therapy, complications (hemorrhagic events and neurological deficits), and long-term outcomes (modified Rankin scale pre- and post-treatment, AVM recanalization, complete obliteration, and deaths). RESULTS: Overall, the analysis included 34 articles (2,799 patients). Grade III Spetzler–Martin AVMs were observed in 34.2% of cases. Notably, 39.3% of patients underwent embolization combined with radiosurgery. The most frequently reported long-term complication was hemorrhage, which occurred in 8.7% of patients at a mean follow-up period of 58.6 months. Further, 6.3% of patients exhibited neurological deficits after an average of 34.7 months. Complete obliteration was achieved in 51.4% of the cases after a mean period of 36 months. Recanalization of AVMs was observed in 3.5% of patients. Long-term death occurred in 4.0% of patients. CONCLUSION: Embolization of AVMs is an increasingly safe strategy with low long-term complications and satisfactory outcomes, especially in patients who have undergone combination therapies. SYSTEMATIC REVIEW REGISTRATION: https://www.crd.york.ac.uk/prospero/ Registration number CRD42020204867. BACKGROUND AVMs. . (AVMs) However longterm long term lacking OBJECTIVE SETTING Alagoas Arapiraca Brazil METHODS MetaAnalyses Meta Analyses criteria MEDLINE PubMed LILACS databases population therapy hemorrhagic deficits, , deficits) modified pre posttreatment, posttreatment post treatment, post-treatment recanalization deaths. deaths deaths) RESULTS Overall 3 2,799 2799 2 799 (2,79 patients) SpetzlerMartin Spetzler Martin 342 34.2 Notably 393 39 39.3 radiosurgery hemorrhage 87 8 7 8.7 followup follow up 586 58 6 58. months Further 63 6.3 347 34. 514 51 4 51.4 35 5 3.5 Longterm Long 40 0 4.0 CONCLUSION therapies REGISTRATION https//www.crd.york.ac.uk/prospero/ httpswwwcrdyorkacukprospero https //www.crd.york.ac.uk/prospero/ www crd york ac uk prospero https://www.crd.york.ac.uk/prospero CRD42020204867 CRD (AVMs 2,79 279 79 (2,7 39. 8. 6. 51. 3. 4. https//www.crd.york.ac.uk/prospero wwwcrdyorkacukprospero //www.crd.york.ac.uk/prospero CRD4202020486 2,7 27 (2, CRD420202048 2, (2 CRD42020204 ( CRD4202020 CRD420202 CRD42020 CRD4202 CRD420 CRD42 CRD4

A alta prevalência de malformação da junção craniovertebral no Nordeste do Brasil é historicamente associada ao biótipo braquicefálico (cabeça chata), também comum nessa região. Postula-se que essa característica tenha sido introduzida na região pelos holandeses durante o período colonial da história do Brasil. Com base na confrontação desse paradigma com alguns fatos históricos, os autores concluem que o fenótipo braquicefálico foi herdado de ancestrais pré-históricos (ameríndios) que já habitavam a região no momento da chegada do homem branco europeu.

The high prevalence of craniovertebral junction malformation in Northeastern Brazil is historically associated with brachycephalic biotype (flat head), also common in this region. It has been postulated that this trait was introduced to this region by the Dutch during the colonial period in Brazil's history. Based on the confrontation of this paradigm against some historical facts, the authors concluded that the brachycephalic phenotype was inherited from prehistoric ancestors (Amerindians) who were already living in this region when white European men arrived.