Musmar B., Adeeb N., Abdalrazeq H., Salim HA., Roy J., Tjoumakaris SI., Kandregula S., Ogilvy CS., Kondziolka D., Sheehan JP., Dmytriw AA., Aslan A., Patel P., Lan M., Baldassari MP., Koduri S., Atallah E., Zeineddine H., Pontarelli M-K., Abou-Al-Shaar H., El Naamani K., Abdelsalam A., Ironside N., Kumbhare D., Gummadi S., Baskaya M., Ataoglu C., Mccarthy F., Sanchez-Forteza A., Essibayi MA., Keles A., Muram S., Sconzo D., Riina H., Rezai A., Alwakaa O., Tos SM., Mantziaris G., Park MS., Hanalioglu S., Erginoglu U., Pöppe J., Sen RD., Griessenauer CJ., Ocampo-Navia MI., Devia DA., Perez-Mendez W., Puentes JC., Abo Kasem R., Spiotta AM., Puri AS., Singh J., Kuhn AL., Burkhardt JK., Starke RM., Sekhar LN., Levitt M., Altschul D., Haranhalli N., McAvoy M., Eltiti M., Abushehab A., Foreman P., Shakir HJ., Zaidat OO., AlMajali M., Ruppert-Gomez M., See AP., Abla AA., Stapleton CJ., Patel A., Nguyen A., Koch MJ., Srinivasan VM., Chen PR., Blackburn S., Alshahrani R., Gooch MR., Rosenwasser RH., Bulsara KR., Kan P., Kim LJ., Choudhri O., Pukenas B., Simonato D., Li Y-L., Alaraj A., Fuschi M., Patel AB., Savardekar A., Notarianni C., Cuellar HH., Lawton MT., Guthikonda B., Morcos J., Jabbour P.

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.

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.

DOI

Type

Publication Date

Keywords