Efficacy and safety of preoperative embolization in surgical treatment of brain arteriovenous malformations: a multicentre study with propensity score matching

Hamza Salim, Department of Radiology, Louisiana State University Health Sciences Center, Shreveport, Louisiana, USA Hamza.sleeem@gmail.com nimer_adeeb@hotmail.com bharat.guthikonda@lsuhs.edu.
Dawoud Hamdan, Department of Radiology, Louisiana State University Health Sciences Center, Shreveport, Louisiana, USA.
Nimer Adeeb, Department of Neurosurgery, Louisiana State University Health Sciences Center, Shreveport, Louisiana, USA Hamza.sleeem@gmail.com nimer_adeeb@hotmail.com bharat.guthikonda@lsuhs.edu.
Sandeep Kandregula, Department of Neurosurgery, University of Pennsylvania, Philadelphia, Pennsylvania, USA.
Assala Aslan, Department of Radiology, Louisiana State University Health Sciences Center, Shreveport, Louisiana, USA.
Basel Musmar, Department of Neurosurgery, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, USA.
Christopher S. Ogilvy, Division of Neurosurgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA.
Adam A. Dmytriw, Division of Diagnostic and Interventional Neuroradiology, Department of Medical Imaging, University of Toronto, Toronto, Ontario, Canada.
Ahmed Abdelsalam, Department of Neurosurgery, University of Miami, Coral Gables, Florida, USA.
Cagdas Ataoglu, Department of Neurosurgery, University of Wisconsin School of Medicine, Madison, Wisconsin, USA.
Ufuk Erginoglu, Department of Neurosurgery, University of Wisconsin School of Medicine, Madison, Wisconsin, USA.
Douglas Kondziolka, Department of Neurosurgery, New York University Grossman School of Medicine, New York, New York, USA.
Kareem El Naamani, Department of Neurosurgery, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, USA.
Jason Sheehan, Department of Neurosurgery, University of Virginia, Charlottesville, Virginia, USA.
Natasha Ironside, Department of Neurosurgery, University of Virginia, Charlottesville, Virginia, USA.
Deepak Kumbhare, Department of Neurosurgery, Louisiana State University Health Sciences Center, Shreveport, Louisiana, USA.
Sanjeev Gummadi, Department of Neurosurgery, Louisiana State University Health Sciences Center, Shreveport, Louisiana, USA.
Muhammed Amir Essibayi, Montefiore Einstein Cerebrovascular Research Lab and Department of Neurological Surgery, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York, USA.
Salem M. Tos, Department of Neurosurgery, University of Texas at Houston, Houston, Texas, USA.
Abdullah Keles, Department of Neurosurgery, University of Wisconsin School of Medicine, Madison, Wisconsin, USA.
Sandeep Muram, Division of Neurosurgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA.
Daniel Sconzo, Division of Neurosurgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA.
Arwin Rezai, Department of Neurosurgery, Christian Doppler Klinik, Paracelsus Medical University, Salzburg, Austria.
Omar Alwakaa, Division of Neurosurgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA.
Johannes Pöppe, Department of Neurosurgery, Christian Doppler Klinik, Paracelsus Medical University, Salzburg, Austria.
Rajeev D. Sen, Department of Neurosurgery, University of Washington, Seattle, Washington, USA.
Mustafa K. Baskaya, Department of Neurosurgery, University of Wisconsin School of Medicine, Madison, Wisconsin, USA.
Christoph J. Griessenauer, Department of Neurosurgery, Christian Doppler Klinik, Paracelsus Medical University, Salzburg, Austria.
Pascal Jabbour, Department of Neurosurgery, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, USA.
Stavropoula I. Tjoumakaris, Department of Neurosurgery, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, USA.
Elias Atallah, Department of Neurosurgery, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, USA.

Document Type

Article

Abstract

BACKGROUND: Brain arteriovenous malformations (AVMs) are abnormal connections between feeding arteries and draining veins, associated with significant risks of haemorrhage, seizures and other neurological deficits. Preoperative embolization is commonly used as an adjunct to microsurgical resection, with the aim of reducing intraoperative complications and improving outcomes. However, the efficacy and safety of this approach remain controversial. METHODS: This study is a subanalysis of the Multicenter International Study for Treatment of Brain AVMs consortium. We retrospectively analysed 486 patients with brain AVMs treated with microsurgical resection between January 2010 and December 2023. Patients were divided into two groups: those who underwent microsurgery alone (n=245) and those who received preoperative embolization, followed by microsurgery (n=241). Propensity score matching was employed, resulting in 288 matched patients (144 in each group). The primary outcomes were rates of complete AVM obliteration and functional outcomes (measured by the modified Rankin Scale (mRS)). Secondary outcomes included complication rates, mortality, hospital length of stay and postsurgical rupture. RESULTS: After matching, the complete obliteration rate was 97% with no significant difference between the microsurgery-only group and the preoperative embolization group (p=0.12). The proportion of patients with an mRS score of 0-2 at the last follow-up was similar in both groups (83% vs 84%; p=0.67). The median hospital stay was significantly longer for the embolisation group (9 days vs 7 days; p=0.017). Complication rates (24% vs 22%; p=0.57) and mortality rates (4.9% vs 2.1%; p=0.20) were comparable between the two groups. No significant differences were observed in postsurgical rupture, recurrence or retreatment rates. CONCLUSIONS: In this large multicentre study, preoperative embolization did not significantly improve AVM obliteration rates, functional outcomes or reduce complications compared with microsurgery alone.

Medical Subject Headings

Adolescent; Adult; Female; Humans; Male; Middle Aged; Young Adult; Embolization, Therapeutic (methods, adverse effects); Intracranial Arteriovenous Malformations (surgery, therapy); Microsurgery (methods); Preoperative Care (methods); Propensity Score; Retrospective Studies; Treatment Outcome

Publication Date

7-16-2025

Publication Title

Journal of neurology, neurosurgery, and psychiatry

E-ISSN

1468-330X

Volume

96

Issue

8

First Page

766

Last Page

774

PubMed ID

39915091

Digital Object Identifier (DOI)

10.1136/jnnp-2024-334974

Link to Full Text

Share

COinS