Journal article
A comparative analysis of microsurgical resection versus stereotactic radiosurgery for Spetzler-Martin grade III arteriovenous malformations: A multicenter propensity score matched study
Clinical neurology and neurosurgery, Vol.249, 108669
02/2025
DOI: 10.1016/j.clineuro.2024.108669
PMID: 39642799
Abstract
Spetzler-Martin (SM) Grade III brain arteriovenous malformations (BAVMs) represent a transitional risk zone between low- and high-grade BAVMs, characterized by diverse angioarchitecture. The primary treatment options are endovascular embolization, microsurgical resection (MS), and stereotactic radiosurgery (SRS). This study compares the efficacy and outcomes of MS and SRS.
We conducted a multicenter, retrospective study involving patients from the MISTA database with SM Grade III BAVMs treated with MS or SRS between 2010 and 2023. Propensity matching was based on age, favorable modified Rankin Score (mRS) at presentation, nidus size, rupture status, location depth, and eloquence.
After matching, 60 patients were equally divided between MS and SRS groups. Median age (MS: 45.0 vs. SRS: 42.5 years, p = 0.3) and AVM size (MS: 3.2 vs. SRS: 2.9 cm3, p = 0.6) were similar. MS showed higher obliteration rates (93.3 %) compared to SRS (46.7 %) at the last follow-up (p < 0.001). The median time to obliteration post-SRS was 31.5 months (IQR: 15.3–60.0). SRS obliteration rates were 19 %, 29 %, and 59 % at 24, 36, and 60 months, respectively. Overall complication rates (MS: 30 % vs. SRS: 20 %, p = 0.4) and permanent complications (MS: 10 % vs. SRS: 13.3 %, p > 0.9) were similar. Hemorrhage occurred once in the MS group and none in the SRS (p > 0.9). Favorable outcomes (mRS 0–2) were higher with SRS than MS (93.3 % vs 80.0 %, p = 0.3), with one AVM-related mortality in the MS group.
MS and SRS are viable treatments for SM Grade III BAVMs. Treatment choice should be individualized by a multidisciplinary team, considering patient goals.
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•MS shows superior obliteration (93.3 %) vs SRS (46.7 %) for SM Grade III AVMs (p < 0.001).•Complete obliteration with MS is immediate vs 31.5 months median time with SRS.•SRS achieves better functional outcomes (mRS 0–2: 93.3 %) compared to MS (80.0 %).•Similar complication rates between treatments (MS: 30 %, SRS: 20 %, p = 0.4).
Details
- Title: Subtitle
- A comparative analysis of microsurgical resection versus stereotactic radiosurgery for Spetzler-Martin grade III arteriovenous malformations: A multicenter propensity score matched study
- Creators
- Salem M. Tos - University of VirginiaBardia Hajikarimloo - University of VirginiaMahmoud Osama - University of VirginiaGeorgios Mantziaris - University of VirginiaNimer Adeeb - The University of Texas Health Science Center at HoustonSandeep Kandregula - University of PennsylvaniaHamza Adel Salim - Louisiana State UniversityBasel Musmar - Thomas Jefferson University HospitalChristopher Ogilvy - Beth Israel Deaconess Medical CenterDouglas Kondziolka - New York UniversityAdam A. Dmytriw - Massachusetts General HospitalKareem El Naamani - Thomas Jefferson University HospitalAhmed Abdelsalam - University of MiamiDeepak Kumbhare - Louisiana State University Health Sciences Center ShreveportSanjeev Gummadi - Louisiana State University Health Sciences Center ShreveportCagdas Ataoglu - University of Wisconsin–MadisonMuhammed Amir Essibayi - Montefiore Medical CenterUfuk Erginoglu - University of Wisconsin–MadisonDaniel Sconzo - Beth Israel Deaconess Medical CenterAbdullah Keles - University of Wisconsin–MadisonHoward Riina - New York UniversitySandeep Muram - Beth Israel Deaconess Medical CenterArwin Rezai - Christian Doppler KlinikJohannes Pöppe - Christian Doppler KlinikRajeev D. Sen - University of WashingtonOmar Alwakaa - Beth Israel Deaconess Medical CenterChristoph J. Griessenauer - Paracelsus Medical UniversityPascal Jabbour - Thomas Jefferson University HospitalStavropoula I. Tjoumakaris - Thomas Jefferson University HospitalJan-Karl BurkhardtRobert M. Starke - University of MiamiMustafa K. Baskaya - University of Wisconsin–MadisonLaligam N. Sekhar - University of WashingtonMichael R. Levitt - University of WashingtonDavid J. Altschul - Montefiore Medical CenterNeil Haranhalli - Montefiore Medical CenterMalia McAvoy - University of WashingtonAbdallah Abushehab - Mayo Clinic HospitalAssala Aslan - Louisiana State UniversityChristian Swaid - Louisiana State University Health Sciences Center ShreveportAdib Abla - University of MiamiChristopher Stapleton - Massachusetts General HospitalMatthew Koch - University of FloridaVisish M. Srinivasan - University of PennsylvaniaPeng R. Chen - The University of Texas Health Science Center at HoustonSpiros Blackburn - The University of Texas Health Science Center at HoustonJoseph Cochran - The University of Texas Health Science Center at HoustonOmar Choudhri - University of PennsylvaniaBryan Pukenas - University of PennsylvaniaDarren Orbach - University of FloridaEdward Smith - Boston Children's HospitalMarkus Möhlenbruch - Heidelberg UniversityAli Alaraj - University of Illinois at ChicagoAli Aziz-SultanKathleen Dlouhy - University of IowaTarek El Ahmadieh - Loma Linda UniversityAman B. Patel - Massachusetts General HospitalAmey Savardekar - Louisiana State University Health Sciences Center ShreveportHugo H. Cuellar - Louisiana State University Health Sciences Center ShreveportMichael Lawton - Barrow Neurological InstituteBharat Guthikonda - Louisiana State University Health Sciences Center ShreveportJacques Morcos - The University of Texas Health Science Center at HoustonJason Sheehan - University of Virginia
- Resource Type
- Journal article
- Publication Details
- Clinical neurology and neurosurgery, Vol.249, 108669
- Publisher
- Elsevier B.V
- DOI
- 10.1016/j.clineuro.2024.108669
- PMID
- 39642799
- ISSN
- 0303-8467
- eISSN
- 1872-6968
- Language
- English
- Date published
- 02/2025
- Academic Unit
- Neurosurgery
- Record Identifier
- 9984757069902771
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