A comparative analysis of microsurgical resection versus stereotactic radiosurgery for Spetzler-Martin grade III arteriovenous malformations: A multicenter propensity score matched study

• Published in: Clinical neurology and neurosurgery 2025-02, Vol.249, Article 108669
• Main Authors: Tos, Salem M., Hajikarimloo, Bardia, Osama, Mahmoud, Mantziaris, Georgios, Adeeb, Nimer, Kandregula, Sandeep, Salim, Hamza Adel, Musmar, Basel, Ogilvy, Christopher, Kondziolka, Douglas, Dmytriw, Adam A., El Naamani, Kareem, Abdelsalam, Ahmed, Kumbhare, Deepak, Gummadi, Sanjeev, Ataoglu, Cagdas, Essibayi, Muhammed Amir, Erginoglu, Ufuk, Keles, Abdullah, Muram, Sandeep, Sconzo, Daniel, Riina, Howard, Rezai, Arwin, Pöppe, Johannes, Sen, Rajeev D., Alwakaa, Omar, Griessenauer, Christoph J., Jabbour, Pascal, Tjoumakaris, Stavropoula I., Burkhardt, Jan-Karl, Starke, Robert M., Baskaya, Mustafa K., Sekhar, Laligam N., Levitt, Michael R., Altschul, David J., Haranhalli, Neil, McAvoy, Malia, Abushehab, Abdallah, Aslan, Assala, Swaid, Christian, Abla, Adib, Stapleton, Christopher, Koch, Matthew, Srinivasan, Visish M., Chen, Peng R., Blackburn, Spiros, Cochran, Joseph, Choudhri, Omar, Pukenas, Bryan, Orbach, Darren, Smith, Edward, Möhlenbruch, Markus, Alaraj, Ali, Aziz-Sultan, Ali, Dlouhy, Kathleen, El Ahmadieh, Tarek, Patel, Aman B., Savardekar, Amey, Cuellar, Hugo H., Lawton, Michael, Guthikonda, Bharat, Morcos, Jacques, Sheehan, Jason
• Format: Article
• Language: English
• Subjects: AVM obliteration; Cerebral arteriovenous malformations; Complication rates and functional outcomes; Resection; Spetzler-Martin Grade III; Stereotactic radiosurgery
• ISSN: 0303-8467
• DOI: 10.1016/j.clineuro.2024.108669

Spetzler-Martin (SM) Grade III brain arteriovenous malformations (BAVMs) represent a transitional risk zone between low- and high-grade BAVMs, characterized by diverse angioarchitecture. The primary treatment options are endovascular embolization, microsurgical resection (MS), and stereotactic radiosurgery (SRS). This study compares the efficacy and outcomes of MS and SRS. We conducted a multicenter, retrospective study involving patients from the MISTA database with SM Grade III BAVMs treated with MS or SRS between 2010 and 2023. Propensity matching was based on age, favorable modified Rankin Score (mRS) at presentation, nidus size, rupture status, location depth, and eloquence. After matching, 60 patients were equally divided between MS and SRS groups. Median age (MS: 45.0 vs. SRS: 42.5 years, p = 0.3) and AVM size (MS: 3.2 vs. SRS: 2.9 cm3, p = 0.6) were similar. MS showed higher obliteration rates (93.3 %) compared to SRS (46.7 %) at the last follow-up (p  0.9) were similar. Hemorrhage occurred once in the MS group and none in the SRS (p > 0.9). Favorable outcomes (mRS 0–2) were higher with SRS than MS (93.3 % vs 80.0 %, p = 0.3), with one AVM-related mortality in the MS group. MS and SRS are viable treatments for SM Grade III BAVMs. Treatment choice should be individualized by a multidisciplinary team, considering patient goals. [Display omitted] •MS shows superior obliteration (93.3 %) vs SRS (46.7 %) for SM Grade III AVMs (p