Safety and efficacy of preoperative embolization in the treatment of brain arteriovenous malformations with perinidal aneurysms and single draining vein: a multicenter study with propensity score-weighting

Basel Musmar, Neurosurgery, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, USA.
Nimer Adeeb, Neurosurgery, Louisiana State University Health Sciences Center Shreveport, Shreveport, Louisiana, USA.
Hammam Abdalrazeq, Neurosurgery, Louisiana State University Health Sciences Center Shreveport, Shreveport, Louisiana, USA.
Hamza Adel Salim, Department of Radiology, Division of Neuroradiology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA.
Joanna Roy, Neurosurgery, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, USA.
Stavropoula I. Tjoumakaris, Neurosurgery, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, USA.
Sandeep Kandregula, Neurosurgery, University of Pennsylvania, Philadelphia, Pennsylvania, USA.
Christopher S. Ogilvy, Neurosurgical Service, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA.
Douglas Kondziolka, Neurosurgery, New York University Medical Center, New York, New York, USA.
Jason P. Sheehan, Neurosurgery, University of Virginia, Charlottesville, Virginia, USA.
Adam A. Dmytriw, Neuroendovascular Program, Massachusetts General Hospital, Boston, Massachusetts, USA.
Assala Aslan, Radiology, Louisiana State University Health Sciences Center Shreveport, Shreveport, Louisiana, USA.
Pious Patel, Neurosurgery, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, USA.
Matthews Lan, Neurosurgery, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, USA.
Michael P. Baldassari, Neurosurgery, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, USA.
Sravanthi Koduri, Neurosurgery, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, USA.
Elias Atallah, Neurosurgery, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, USA.
Hussein Zeineddine, Neurosurgery, UTHealth Houston, Houston, Texas, USA.
Mary-Katharine Pontarelli, Neurosurgery, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, USA.
Hussam Abou-Al-Shaar, Neurosurgery, UTHealth Houston, Houston, Texas, USA.
Kareem El Naamani, Neurosurgery, Banner Health, Phoenix, Arizona, USA.
Ahmed Abdelsalam, Neurosurgery, University of Miami Health System, Miami, Florida, USA.
Natasha Ironside, Neurosurgery, University of Virginia, Charlottesville, Virginia, USA.
Deepak Kumbhare, Neurosurgery, Louisiana State University Health Sciences Center Shreveport, Shreveport, Louisiana, USA.
Sanjeev Gummadi, Neurosurgery, Louisiana State University Health Sciences Center Shreveport, Shreveport, Louisiana, USA.
Mustafa Baskaya, Neurosurgery, University of Wisconsin System, Madison, Wisconsin, USA.
Cagdas Ataoglu, Neurosurgery, University of Wisconsin System, Madison, Wisconsin, USA.
Finn Mccarthy, Neurosurgery, University of Illinois Chicago, Chicago, Illinois, USA.
Anthony Sanchez-Forteza, Neurosurgery, University of Illinois Chicago, Chicago, Illinois, USA.
Muhammed Amir Essibayi, Neurosurgery, Montefiore Einstein Hospital, New York, New York, USA.
Abdullah Keles, Neurosurgery, University of Wisconsin System, Madison, Wisconsin, USA.

Document Type

Article

Abstract

BACKGROUND AND OBJECTIVES: Arteriovenous malformations (AVMs) with perinidal aneurysms and single draining vein are associated with an elevated risk of rupture and increased procedural complexity. The role of preoperative embolization in this high-risk anatomical subset remains unclear. This study aimed to evaluate the safety and efficacy of microsurgery with preoperative embolization, compared with microsurgery alone in patients with such AVMs. METHODS: We conducted a multicenter retrospective analysis of an AVM registry from the MISTA (Multicenter International Study for Treatment of Brain AVMs) consortium and included AVMs with perinidal aneurysms and a single draining vein. Baseline characteristics, angiographic outcomes, functional outcomes, and complication rates were compared. Propensity score weighting (PSW) using the covariate balancing method was applied to adjust for baseline differences. RESULTS: Out of a total of 1919 patients, 65 met the inclusion criteria; 45 patients underwent preoperative embolization followed by microsurgery, and 20 underwent microsurgery alone. After adjustment, complete obliteration rates were similar between groups (OR 0.87, 95% CI 0.04 to 16.33, P=0.92), as were rates of functional independence at discharge and follow-up. Overall complication, symptomatic complication, and mortality rates did not differ significantly between groups. However, permanent complications were significantly lower in patients with preoperative embolization (OR 0.06, 95% CI 0.004 to 0.84, P=0.03). DISCUSSION: In patients with AVMs featuring perinidal aneurysms and single draining vein, preoperative embolization followed by microsurgery was associated with fewer permanent complications and no increase in adverse outcomes compared with microsurgery alone. However, given the small number of events, this finding should be interpreted cautiously.

Publication Date

8-22-2025

Publication Title

Journal of neurointerventional surgery

E-ISSN

1759-8486

PubMed ID

40846482

Digital Object Identifier (DOI)

10.1136/jnis-2025-023873

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