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A comparative analysis of microsurgical resection versus stereotactic radiosurgery for Spetzler-Martin grade III arteriovenous malformations: a multicenter propensity score matched study

Background - 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 stere...

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Main Authors: Tos, Salem (Author) , Hajikarimloo, Bardia (Author) , Osama, Mahmoud (Author) , Mantziaris, Georgios (Author) , Adeeb, Nimer (Author) , Kandregula, Sandeep (Author) , Salim, Hamza Adel (Author) , Musmar, Basel (Author) , Ogilvy, Christopher (Author) , Kondziolka, Douglas (Author) , Dmytriw, Adam A. (Author) , El Naamani, Kareem (Author) , Abdelsalam, Ahmed (Author) , Kumbhare, Deepak (Author) , Gummadi, Sanjeev (Author) , Ataoglu, Cagdas (Author) , Essibayi, Muhammed Amir (Author) , Erginoglu, Ufuk (Author) , Keles, Abdullah (Author) , Muram, Sandeep (Author) , Sconzo, Daniel (Author) , Riina, Howard (Author) , Rezai, Arwin (Author) , Pöppe, Johannes (Author) , Sen, Rajeev D. (Author) , Alwakaa, Omar (Author) , Griessenauer, Christoph J. (Author) , Jabbour, Pascal (Author) , Tjoumakaris, Stavropoula I. (Author) , Burkhardt, Jan-Karl (Author) , Starke, Robert M. (Author) , Baskaya, Mustafa K. (Author) , Sekhar, Laligam N. (Author) , Levitt, Michael R. (Author) , Altschul, David J. (Author) , Haranhalli, Neil (Author) , McAvoy, Malia (Author) , Abushehab, Abdallah (Author) , Aslan, Assala (Author) , Swaid, Christian (Author) , Abla, Adib (Author) , Stapleton, Christopher (Author) , Koch, Matthew (Author) , Srinivasan, Visish M. (Author) , Chen, Peng R. (Author) , Blackburn, Spiros (Author) , Cochran, Joseph (Author) , Choudhri, Omar (Author) , Pukenas, Bryan (Author) , Orbach, Darren (Author) , Smith, Edward (Author) , Möhlenbruch, Markus Alfred (Author) , Alaraj, Ali (Author) , Aziz-Sultan, Ali (Author) , Dlouhy, Kathleen (Author) , El Ahmadieh, Tarek (Author) , Patel, Aman B. (Author) , Savardekar, Amey (Author) , Cuellar, Hugo H. (Author) , Lawton, Michael (Author) , Guthikonda, Bharat (Author) , Morcos, Jacques (Author) , Sheehan, Jason (Author)
Format: Article (Journal)
Language:English
Published: February 2025
In: Clinical neurology and neurosurgery
Year: 2025, Volume: 249, Pages: 1-10
ISSN:1872-6968
DOI:10.1016/j.clineuro.2024.108669
Online Access:Verlag, lizenzpflichtig, Volltext: https://doi.org/10.1016/j.clineuro.2024.108669
Verlag, lizenzpflichtig, Volltext: https://www.sciencedirect.com/science/article/pii/S0303846724005560
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Author Notes:Salem M. Tos, Bardia Hajikarimloo, Mahmoud Osama, Georgios Mantziaris, Nimer Adeeb, Sandeep Kandregula, Hamza Adel Salim, Basel Musmar, Christopher Ogilvy, Douglas Kondziolka, Adam A. Dmytriw, Kareem El Naamani, Ahmed Abdelsalam, Deepak Kumbhare, Sanjeev Gummadi, Cagdas Ataoglu, Muhammed Amir Essibayi, Ufuk Erginoglu, Abdullah Keles, Sandeep Muram, Daniel Sconzo, Howard Riina, Arwin Rezai, Johannes Pöppe, Rajeev D. Sen, Omar Alwakaa, Christoph J. Griessenauer, Pascal Jabbour, Stavropoula I. Tjoumakaris, Jan-Karl Burkhardt, Robert M. Starke, Mustafa K. Baskaya, Laligam N. Sekhar, Michael R. Levitt, David J. Altschul, Neil Haranhalli, Malia McAvoy, Abdallah Abushehab, Assala Aslan, Christian Swaid, Adib Abla, Christopher Stapleton, Matthew Koch, Visish M. Srinivasan, Peng R. Chen, Spiros Blackburn, Joseph Cochran, Omar Choudhri, Bryan Pukenas, Darren Orbach, Edward Smith, Markus Möhlenbruch, Ali Alaraj, Ali Aziz-Sultan, Kathleen Dlouhy, Tarek El Ahmadieh, Aman B. Patel, Amey Savardekar, Hugo H. Cuellar, Michael Lawton, Bharat Guthikonda, Jacques Morcos, Jason Sheehan
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Summary:Background - 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. - Methods - 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. - Results - 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: 2.9cm3, 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. - Conclusion - MS and SRS are viable treatments for SM Grade III BAVMs. Treatment choice should be individualized by a multidisciplinary team, considering patient goals.
Item Description:Online verfügbar: 3. Dezember 2024, Artikelversion: 5. Dezember 2024
Gesehen am 11.06.2025
Physical Description:Online Resource
ISSN:1872-6968
DOI:10.1016/j.clineuro.2024.108669

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