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Comparative Study
. 2025 Feb:249:108669.
doi: 10.1016/j.clineuro.2024.108669. Epub 2024 Dec 3.

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

Salem M Tos  1 , Bardia Hajikarimloo  1 , Mahmoud Osama  1 , Georgios Mantziaris  1 , Nimer Adeeb  2 , Sandeep Kandregula  3 , Hamza Adel Salim  4 , Basel Musmar  5 , Christopher Ogilvy  6 , Douglas Kondziolka  7 , Adam A Dmytriw  8 , Kareem El Naamani  5 , Ahmed Abdelsalam  9 , Deepak Kumbhare  10 , Sanjeev Gummadi  10 , Cagdas Ataoglu  11 , Muhammed Amir Essibayi  12 , Ufuk Erginoglu  11 , Abdullah Keles  11 , Sandeep Muram  6 , Daniel Sconzo  6 , Howard Riina  7 , Arwin Rezai  13 , Johannes Pöppe  13 , Rajeev D Sen  14 , Omar Alwakaa  6 , Christoph J Griessenauer  13 , Pascal Jabbour  5 , Stavropoula I Tjoumakaris  5 , Jan-Karl Burkhardt  3 , Robert M Starke  9 , Mustafa K Baskaya  11 , Laligam N Sekhar  14 , Michael R Levitt  14 , David J Altschul  12 , Neil Haranhalli  12 , Malia McAvoy  14 , Abdallah Abushehab  15 , Assala Aslan  4 , Christian Swaid  10 , Adib Abla  9 , Christopher Stapleton  16 , Matthew Koch  17 , Visish M Srinivasan  3 , Peng R Chen  18 , Spiros Blackburn  18 , Joseph Cochran  18 , Omar Choudhri  3 , Bryan Pukenas  3 , Darren Orbach  17 , Edward Smith  19 , Markus Möhlenbruch  20 , Ali Alaraj  21 , Ali Aziz-Sultan  22 , Kathleen Dlouhy  23 , Tarek El Ahmadieh  24 , Aman B Patel  16 , Amey Savardekar  10 , Hugo H Cuellar  10 , Michael Lawton  25 , Bharat Guthikonda  10 , Jacques Morcos  18 , Jason Sheehan  26
Affiliations
Comparative Study

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

Salem M Tos et al. Clin Neurol Neurosurg. 2025 Feb.

Abstract

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 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.

Conclusion: MS and SRS are viable treatments for SM Grade III BAVMs. Treatment choice should be individualized by a multidisciplinary team, considering patient goals.

Keywords: AVM obliteration; Cerebral arteriovenous malformations; Complication rates and functional outcomes; Resection; Spetzler-Martin Grade III; Stereotactic radiosurgery.

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Conflict of interest statement

Declaration of Competing Interest The researchers reported that there was no conflict of interest

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