Comparing stand-alone endovascular embolization versus stereotactic radiosurgery in the treatment of arteriovenous malformations with Spetzler-Martin grades I-III: a propensity score matched study

Authors

Basel Musmar, Department of Neurological Surgery, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, USA.
Nimer Adeeb, Department of Neurosurgery, Louisiana State University Health Science Center, Shreveport, Louisiana, USA.
Joanna M. Roy, Department of Neurological Surgery, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, USA.
Hammam Abdalrazeq, Department of Neurological Surgery, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, USA.
Stavropoula I. Tjoumakaris, Department of Neurological Surgery, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, USA.
Elias Atallah, Department of Neurological Surgery, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, USA.
Hamza Adel Salim, Department of Radiology, Louisiana State University, Shreveport, Louisiana, USA.
Douglas Kondziolka, Department of Neurosurgery, New York University Grossman School of Medicine, New York, New York, USA.
Jason Sheehan, Department of Neurosurgery, University of Virginia, Charlottesville, Virginia, USA.
Christopher S. Ogilvy, Department of Neurosurgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA.
Howard Riina, Department of Neurosurgery, New York University Grossman School of Medicine, New York, New York, USA.
Sandeep Kandregula, Department of Neurosurgery, University of Pennsylvania, Philadelphia, Pennsylvania, USA.
Adam A. Dmytriw, Neuroendovascular Program, Massachusetts General Hospital, Boston, Massachusetts, USA.
Kareem El Naamani, Department of Neurological Surgery, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, USA.
Ahmed Abdelsalam, Department of Neurosurgery, University of Miami, Miller School of Medicine, Miami, FL, USA.
Natasha Ironside, Department of Neurosurgery, University of Virginia, Charlottesville, Virginia, USA.
Deepak Kumbhare, Department of Neurosurgery, Louisiana State University Health Science Center, Shreveport, Louisiana, USA.
Cagdas Ataoglu, Department of Neurosurgery, University of Wisconsin School of Medicine, Madison, WI, USA.
Muhammed Amir Essibayi, Montefiore Einstein Cerebrovascular Research Lab and Department of Neurological Surgery, Montefiore Medical Center, Albert Einstein College of Medicine, New York, New York, USA.
Abdullah Keles, Department of Neurosurgery, University of Wisconsin School of Medicine, Madison, WI, USA.
Sandeep Muram, Department of Neurosurgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA.
Daniel Sconzo, Department of Neurosurgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA.
Arwin Rezai, Department of Neurosurgery, Christian Doppler Klinik, Paracelsus Medical University, Salzburg, Austria.
Ufuk Erginoglu, Department of Neurosurgery, University of Wisconsin School of Medicine, Madison, WI, USA.
Johannes Pöppe, Department of Neurosurgery, Christian Doppler Klinik, Paracelsus Medical University, Salzburg, Austria.
Rajeev D. Sen, Department of Neurosurgery, University of Washington, Seattle, WA, USA.
Christoph J. Griessenauer, Department of Neurosurgery, Christian Doppler Klinik, Paracelsus Medical University, Salzburg, Austria.
Jan-Karl Burkhardt, Department of Neurosurgery, University of Pennsylvania, Philadelphia, Pennsylvania, USA.
Robert M. Starke, Department of Neurosurgery, University of Miami, Miller School of Medicine, Miami, FL, USA.
Mustafa K. Baskaya, Department of Neurosurgery, University of Wisconsin School of Medicine, Madison, WI, USA.
Laligam N. Sekhar, Department of Neurosurgery, University of Washington, Seattle, WA, USA.

Document Type

Article

Abstract

BACKGROUND: Arteriovenous malformations (AVMs) are uncommon cerebral lesions that can cause significant neurological complications. Surgical resection is the gold standard for treatment, but endovascular embolization and stereotactic radiosurgery (SRS) are viable alternatives. OBJECTIVE: To compare the outcomes of endovascular embolization versus SRS in the treatment of AVMs with Spetzler-Martin grades I-III. METHODS: This study combined retrospective data from 10 academic institutions in North America and Europe. Patients aged 1 to 90 years who underwent endovascular embolization or SRS for AVMs with Spetzler-Martin grades I-III between January 2010 and December 2023 were included. RESULTS: The study included 244 patients, including 84 who had endovascular embolization and 160 who had SRS. Before propensity score matching (PSM), complete obliteration at the last follow-up was achieved in 74.5% of the SRS group compared with 57.8% of the embolization group (OR=0.47; 95% CI 0.26 to 0.48; P=0.01). After propensity score matching, SRS still achieved significantly higher occlusion rates at last follow-up (78.9% vs 55.3%; OR=0.32; 95% CI 0.12 to 0.90; P=0.03).Hemorrhagic complications were higher in the embolization group than in the SRS group, although this difference did not reach statistical significance after PSM (13.2% vs 2.6%; OR=5.6; 95% CI 0.62 to 50.47; P=0.12). Similarly, re-treatment rate was higher in the embolization group (10.5% vs 5.3%; OR=2.11; 95% CI 0.36 to 12.31; P=0.40) compared with the SRS group. CONCLUSION: Our findings indicate that SRS has a significantly higher obliteration rate at last follow-up compared with endovascular embolization. Also, SRS has a higher tendency for fewer hemorrhagic complications and lower re-treatment rate. Further prospective studies are needed.

Medical Subject Headings

Humans; Radiosurgery (methods); Embolization, Therapeutic (methods); Intracranial Arteriovenous Malformations (therapy, diagnostic imaging, surgery); Male; Adolescent; Propensity Score; Retrospective Studies; Female; Child; Adult; Middle Aged; Young Adult; Aged; Child, Preschool; Treatment Outcome; Aged, 80 and over; Infant; Endovascular Procedures (methods); Follow-Up Studies

Publication Date

11-18-2025

Publication Title

Journal of neurointerventional surgery

E-ISSN

1759-8486

Volume

17

Issue

12

First Page

1382

Last Page

1390

PubMed ID

39366733

Digital Object Identifier (DOI)

10.1136/jnis-2024-022326

Recommended Citation

Musmar, Basel; Adeeb, Nimer; Roy, Joanna M.; Abdalrazeq, Hammam; Tjoumakaris, Stavropoula I.; Atallah, Elias; Salim, Hamza Adel; Kondziolka, Douglas; Sheehan, Jason; Ogilvy, Christopher S.; Riina, Howard; Kandregula, Sandeep; Dmytriw, Adam A.; El Naamani, Kareem; Abdelsalam, Ahmed; Ironside, Natasha; Kumbhare, Deepak; Ataoglu, Cagdas; Essibayi, Muhammed Amir; Keles, Abdullah; Muram, Sandeep; Sconzo, Daniel; Rezai, Arwin; Erginoglu, Ufuk; Pöppe, Johannes; Sen, Rajeev D.; Griessenauer, Christoph J.; Burkhardt, Jan-Karl; Starke, Robert M.; Baskaya, Mustafa K.; and Sekhar, Laligam N., "Comparing stand-alone endovascular embolization versus stereotactic radiosurgery in the treatment of arteriovenous malformations with Spetzler-Martin grades I-III: a propensity score matched study" (2025). Neurosurgery. 2252.
https://scholar.barrowneuro.org/neurosurgery/2252