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Comparative Study
. 2025 Feb 28;48(1):276.
doi: 10.1007/s10143-025-03431-2.

Spetzler-Martin grade I and II cerebral arteriovenous malformations: a propensity-score matched analysis of resection and stereotactic radiosurgery in adult patients

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

Spetzler-Martin grade I and II cerebral arteriovenous malformations: a propensity-score matched analysis of resection and stereotactic radiosurgery in adult patients

Salem M Tos et al. Neurosurg Rev. .

Abstract

Cerebral arteriovenous malformations (AVMs) are congenital vascular anomalies that can lead to severe complications, including hemorrhage and neurological deficits. This study compares the outcomes of microsurgical resection and stereotactic radiosurgery (SRS) for SM grade I and II AVMs. Out of a large multicenter registry, we identified 180 matched patients with SM grade I and II AVMs treated with either microsurgical resection or SRS between 2010 and 2023. The primary outcomes were AVM obliteration rates and complications; secondary outcomes included neurological status and functional outcomes measured by the modified Rankin Scale (mRS). Propensity score matching (PSM) was utilized to ensure comparability between treatment groups. After PSM, 90 patients were allocated to each treatment group. Significant differences were observed in complete obliteration rates, with resection achieving higher rates compared to SRS in overall cases (97.8% vs. 60.0%, p < 0.001), unruptured AVMs (100% vs. 58.3%, p < 0.001), and ruptured AVMs (95.2% vs. 61.9%, p < 0.001). Functional improvement rates were similar between the groups for overall cases (67.2% in resection vs. 66.7% in SRS, p = 0.95), unruptured AVMs (55.2% in resection vs. 55.6% in SRS, p > 0.9), and ruptured AVMs (78.1% in resection vs. 74.1% in SRS, p = 0.7). Symptomatic complication rates were identical between the groups (11.1% each, p > 0.9), while permanent complication rates were comparable (6.7% in resection vs. 5.6% in SRS, p = 0.8). Resection demonstrated significantly higher complete obliteration rates compared to SRS across all cases, including unruptured and ruptured AVMs. Functional improvement rates were similar between the two treatment groups, with no significant differences in symptomatic or permanent complication rates.

Keywords: AVM obliteration; Cerebral arteriovenous malformations; Complication rates; Functional outcomes; Resection; Spetzler-Martin grade I and II; Stereotactic radiosurgery.

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Conflict of interest statement

Declarations. Ethical approval: This retrospective multicenter clinical cohort study was conducted in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards. The study protocol was reviewed and approved by the Institutional Review Board (IRB) of University of Virginia Hospital. Due to the retrospective nature of the study, the requirement for informed consent was waived by the IRB. All patient data were anonymized and de-identified prior to analysis to ensure patient confidentiality. Conflict of interest: The researchers reported that there was no conflict of interest Disclosure: Dr. Griessenauer reported personal fees from MicroVention and Stryker, proctoring for Medtronic, and grants from Penumbra and Baxter outside the submitted work. Dr. Tjoumakaris reported being a consultant for MicroVention. Dr. Burkhardt reported being a consultant for MicroVention, Stryker, Q’Apel, Cerenovos, and Longeviti Neuro Solutions outside the submitted work. Dr. Möhlenbruch reported grants from Balt, MicroVention, Medtronic, and Stryker outside the submitted work. A. B. Patel reported personal fees from MicroVention, Medtronic, and Penumbra outside the submitted work.Dr. Cuellar reported being a consultant for MicroVention. The rest of authors declared no personal, financial, or institutional interests related to the drugs, materials, or devices discussed in the article. Consent to participate: The study was approved by institutional review boards, with waived informed consent due to its retrospective design. Data was de-identified for confidentiality. Clinical trial number: Not applicable.

Figures

Fig. 1
Fig. 1
High-dose radiation beams are precisely targeted to the AVM, minimizing exposure to surrounding brain tissue and leading to gradual AVM obliteration
Fig. 2
Fig. 2
Cumulative incidence of AVM obliteration post-radiosurgery over time
Fig. 3
Fig. 3
Cumulative incidence of unruptured and unruptured AVM obliteration post-radiosurgery over time
Fig. 4
Fig. 4
Comparison of the Patient, AVM, and Treatment Characteristics of the Matched Resection and Stereotactic Radiosurgery Cohorts
See this image and copyright information in PMC

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