Faculty, Staff and Student Publications

Language

English

Publication Date

3-31-2025

Journal

Neurosurgical Review

DOI

10.1007/s10143-025-03465-6

PMID

40159532

PMCID

PMC11955433

PubMedCentral® Posted Date

3-31-2025

PubMedCentral® Full Text Version

Post-print

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.

Keywords

Humans, Radiosurgery, Female, Male, Intracranial Arteriovenous Malformations, Adult, Propensity Score, Middle Aged, Retrospective Studies, Microsurgery, Treatment Outcome, Aged, Young Adult, Neurosurgical Procedures, Cerebral arteriovenous malformations, Spetzler-martin grade IV, Resection, Stereotactic radiosurgery, AVM obliteration, Complication rates and functional outcomes

Published Open-Access

yes

Additional Files
10143_2025_3465_Figa_HTML.jpg (115 kB)
Graphical Abstract
Download

Share

COinS
 
 

To view the content in your browser, please download Adobe Reader or, alternately,
you may Download the file to your hard drive.

NOTE: The latest versions of Adobe Reader do not support viewing PDF files within Firefox on Mac OS and if you are using a modern (Intel) Mac, there is no official plugin for viewing PDF files within the browser window.