Abstract
<title>Abstract</title> <p> Background. Sylvian-fissure-region arteriovenous malformations (AVMs) are uncommon and anatomically heterogeneous; published labels often describe non-comparable lesions or populations. Objective. To update evidence for microsurgery, stereotactic radiosurgery (SRS), and endovascular treatment (EVT). Methods. Following PRISMA 2020, five databases were searched through May 2026 with citation chaining. Two reviewers independently screened records and extracted data. Dedicated sylvian/perisylvian cohorts were distinguished from broader cohorts and contextual technical reports. Incompatible endpoints, non-independent arms, and potentially overlapping cohorts were not pooled. Risk of bias and applicability were appraised. Results. Nineteen reports were retained: 16 in the evidence synthesis and 3 as contextual background. Microsurgery achieved complete resection in 8/8, 40/41, and 94/94 patients. Transient deficits occurred in 4/8, 4/28, 9/94, and 18/41 patients; postoperative hematoma occurred in 2/94. Mortality windows varied. In the dedicated SRS cohort (n = 87), actuarial obliteration was 35% at 3 years, 60% at 4–5 years, and 76% at 10 years. Cumulative post-SRS hemorrhage was 5% at 1, 5, and 10 years (approximately 1% annually during latency); mortality was unreported. No dedicated curative EVT series for true sylvian AVMs was identified; available data described broader middle cerebral artery cohorts without sylvian-specific angiographic cure. Conclusions. Microsurgery is supported for carefully selected accessible sylvian-fissure AVMs, whereas SRS and embolization have complementary roles. Comparative superiority cannot be inferred. Future studies require explicit anatomical definitions, modality-specific denominators, angiographic endpoints, and standardized follow-up. <bold>Clinical Trial Number:</bold> not applicable. </p>