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

被引：1

作者：

Tos, Salem M. ^{[1
]}

Hajikarimloo, Bardia ^{[1
]}

Osama, Mahmoud ^{[1
]}

Mantziaris, Georgios ^{[1
]}

Adeeb, Nimer ^{[2
,3
]}

Kandregula, Sandeep ^{[4
]}

Salim, Hamza Adel ^{[5
]}

Musmar, Basel ^{[6
]}

Ogilvy, Christopher ^{[7
]}

Kondziolka, Douglas ^{[8
]}

Dmytriw, Adam A. ^{[9
,18
]}

El Naamani, Kareem ^{[6
]}

Abdelsalam, Ahmed ^{[10
]}

Kumbhare, Deepak ^{[2
]}

Gummadi, Sanjeev ^{[2
]}

Ataoglu, Cagdas ^{[11
]}

Essibayi, Muhammed Amir ^{[12
,13
]}

Erginoglu, Ufuk ^{[11
]}

Keles, Abdullah ^{[11
]}

Muram, Sandeep ^{[7
]}

Sconzo, Daniel ^{[7
]}

Riina, Howard ^{[8
]}

Rezai, Arwin ^{[14
]}

Poeppe, Johannes

Sen, Rajeev D. ^{[15
]}

Alwakaa, Omar

Griessenauer, Christoph J. ^{[14
]}

Jabbour, Pascal ^{[6
]}

Tjoumakaris, Stavropoula I. ^{[6
]}

Burkhardt, Jan-Karl ^{[4
]}

Starke, Robert M. ^{[10
]}

Baskaya, Mustafa K.

Sekhar, Laligam N. ^{[15
]}

Levitt, Michael R. ^{[15
]}

Altschul, David J.

Haranhalli, Neil

Mcavoy, Malia

Abushehab, Abdallah ^{[16
]}

Aslan, Assala

Swaid, Christian

Abla, Adib ^{[10
]}

Stapleton, Christopher ^{[9
]}

Koch, Matthew ^{[17
]}

Srinivasan, Visish M. ^{[4
]}

Chen, Peng R. ^{[3
]}

Blackburn, Spiros ^{[3
]}

Cochran, Joseph ^{[3
]}

Choudhri, Omar

Pukenas, Bryan

Orbach, Darren ^{[17
]}

机构：

[1] Univ Virginia, Dept Neurosurg, Charlottesville, VA USA

[2] Louisiana State Univ Hlth Sci Ctr, Dept Neurosurg, Shreveport, LA USA

[3] UT Hlth Sci Ctr Houston, McGovern Med Sch, Dept Neurosurg, Houston, TX USA

[4] Univ Penn, Dept Neurosurg, Philadelphia, PA USA

[5] Louisiana State Univ, Dept Radiol, New Orleans, LA USA

[6] Thomas Jefferson Univ Hosp, Dept Neurosurg, Philadelphia, PA 19107 USA

[7] Harvard Med Sch, Beth Israel Deaconess Med Ctr, Div Neurosurg, Boston, MA 02115 USA

[8] New York Univ Grossman Sch Med, Dept Neurosurg, New York, NY 10016 USA

[9] Harvard Med Sch, Massachusetts Gen Hosp, Neuroendovasc Program, Boston, MA USA

[10] Univ Miami, Dept Neurosurg, Miami, FL USA

[11] Univ Wisconsin, Sch Med, Dept Neurosurg, Madison, WI USA

[12] Albert Einstein Coll Med, Montefiore Med Ctr, Montefiore Einstein Cerebrovascular Res Lab, Bronx, NY USA

[13] Albert Einstein Coll Med, Montefiore Med Ctr, Dept Neurol Surg, Bronx, NY USA

[14] Paracelsus Med Univ, Dept Neurosurg, Christian Doppler Klin, Salzburg, Austria

[15] Washington Univ, Washington, DC 20052 USA

[16] Mayo Clin Hosp, Dept Plast Surg, Phoenix, AZ 85054 USA

[17] Univ Florida, Dept Neurosurg, Gainesville, FL USA

[18] Harvard Med Sch, Boston Childrens Hosp, Neurointervent Radiol, Boston, MA 02115 USA

[19] Harvard Med Sch, Boston Childrens Hosp, Dept Neurosurg, Boston, MA 02115 USA

[20] Heidelberg Univ Hosp, Dept Neuroradiol, D-69120 Heidelberg, Germany

[21] Univ Illinois, Dept Neurosurg, Chicago, IL USA

[22] Univ Iowa, Dept Neurosurg, Iowa City, IA USA

[23] Loma Linda Univ, Dept Neurosurg, Redlands, CA USA

[24] Barrow Neurol Inst, Dept Neurosurg, Phoenix, AZ USA

[25] Univ Virginia, Dept Neurol Surg, Box 800212, Charlottesville, VA 22908 USA

来源：

CLINICAL NEUROLOGY AND NEUROSURGERY | 2025年 / 249卷

关键词：

Cerebral arteriovenous malformations; Spetzler-Martin Grade III; Resection; Stereotactic radiosurgery; AVM obliteration; Complication rates and functional outcomes; RADIO SURGERY;

D O I：

10.1016/j.clineuro.2024.108669

中图分类号：

R74 [神经病学与精神病学];

学科分类号：

摘要：

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: 2.9 cm(3), 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.

引用

页数：10