Journal article
Spetzler-martin grade IV cerebral arteriovenous malformations in adult patients: a propensity-score matched analysis of resection and stereotactic radiosurgery
Neurosurgical review, Vol.48(1), 337
03/31/2025
DOI: 10.1007/s10143-025-03465-6
PMCID: PMC11955433
PMID: 40159532
Abstract
Spetzler-Martin Grade IV arteriovenous malformations (AVMs) are challenging due to high risks associated with both treatment and natural progression. This study compares the outcomes of microsurgical resection and stereotactic radiosurgery (SRS) in high-grade AVMs, analyzing obliteration rates, complications, and functional outcomes. A retrospective cohort of 96 patients treated with either microsurgical resection (33 patients) or SRS (63 patients) was analyzed. Propensity-score matching was employed to account for baseline variables such as AVM size (cm), preoperative embolization and rupture status. Primary endpoints included AVM obliteration, complication rates, and modified Rankin Scale (mRS) scores. After matching, 31 patients per group were analyzed. Microsurgical resection achieved significantly higher obliteration rates (87.1%) compared to SRS (32.3%, p < 0.001). In the matched SRS cohort (n = 31), the actuarial obliteration rates were 11% (95% CI: 0-22%) at 1 year, 17% (95% CI: 0-31%) at 3 years, and 43% (95% CI: 13-63%) at 5 years post-treatment. Complication rates were similar (32.3% resection, 38.7% SRS, p = 0.6). Functional outcomes in terms of improvement in modified Rankin Scale (mRS) scores were observed in 50.0% of microsurgery patients and 41.4% of SRS patients. However, the absolute number of patients improving was similar (13 vs. 12), and the microsurgery group had more cases of worsening mRS scores compared to the SRS group (4 vs. 2). The difference was not statistically significant (p = 0.4). Microsurgical resection offers superior obliteration rates for high-grade AVMs with comparable complication risks to SRS. SRS remains a valuable alternative for select patients, particularly those ineligible for resection. Future research should focus on optimizing multimodal treatment approaches. Clinical trial number Not applicable.
Details
- Title: Subtitle
- Spetzler-martin grade IV cerebral arteriovenous malformations in adult patients: a propensity-score matched analysis of resection and stereotactic radiosurgery
- Creators
- Salem M Tos - University of VirginiaKathleen Dlouhy - University of IowaMahmoud Osama - University of VirginiaGeorgios Mantziaris - University of VirginiaBardia Hajikarimloo - 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 S Ogilvy - Beth Israel Deaconess Medical CenterDouglas Kondziolka - New York UniversityAdam A Dmytriw - Harvard Medical SchoolKareem El Naamani - Thomas Jefferson University HospitalAhmed Abdelsalam - University of MiamiDeepak Kumbhare - Louisiana State UniversitySanjeev Gummadi - Louisiana State UniversityCagdas Ataoglu - University of Wisconsin–MadisonMuhammed Amir Essibayi - Albert Einstein College of MedicineUfuk Erginoglu - University of Wisconsin School of Medicine and Public HealthDaniel Sconzo - Beth Israel Deaconess Medical CenterAbdullah Keles - University of Wisconsin School of Medicine and Public HealthHoward Riina - New York UniversityArwin Rezai - Paracelsus Medical UniversitySandeep Muram - Beth Israel Deaconess Medical CenterJohannes Pöppe - Paracelsus Medical UniversityRajeev D Sen - University of WashingtonLouis J Kim - 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 Burkhardt - University of PennsylvaniaRobert M Starke - University of MiamiMustafa K Baskaya - University of Wisconsin–MadisonLaligam N Sekhar - University of WashingtonMichael R Levitt - University of WashingtonDavid J Altschul - Albert Einstein College of MedicineNeil Haranhalli - Albert Einstein College of MedicineMalia McAvoy - Mayo Clinic HospitalAbdallah Abushehab - University of FloridaAssala Aslan - Louisiana State UniversityChristian Swaid - Louisiana State UniversityAdib Abla - University of MiamiChristopher Stapleton - Harvard Medical SchoolMatthew Koch - Boston Children's HospitalVisish 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 HoustonOmar Choudhri - University of PennsylvaniaBryan Pukenas - University of PennsylvaniaDarren Orbach - Harvard Medical SchoolEdward Smith - Boston Children's HospitalMarkus Möhlenbruch - University Hospital HeidelbergAli Alaraj - University of Illinois Urbana-ChampaignAli Aziz-Sultan - Brigham and Women's HospitalAman B Patel - Harvard Medical SchoolAmey Savardekar - Louisiana State UniversityHugo H Cuellar - Louisiana State UniversityTarek El Ahmadieh - Loma Linda UniversityMichael Lawton - Barrow Neurological InstituteAdnan Siddiqui - University at Buffalo, State University of New YorkJacques Morcos - The University of Texas Health Science Center at HoustonBharat Guthikonda - Louisiana State UniversityJason Sheehan - University of Virginia
- Resource Type
- Journal article
- Publication Details
- Neurosurgical review, Vol.48(1), 337
- DOI
- 10.1007/s10143-025-03465-6
- PMID
- 40159532
- PMCID
- PMC11955433
- NLM abbreviation
- Neurosurg Rev
- ISSN
- 1437-2320
- eISSN
- 1437-2320
- Publisher
- SPRINGER
- Language
- English
- Date published
- 03/31/2025
- Academic Unit
- Neurosurgery
- Record Identifier
- 9984805005202771
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