Spetzler-martin grade IV cerebral arteriovenous malformations in adult patients: a propensity-score matched analysis of resection and stereotactic radiosurgery
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Le résumé fourni par la source
Spetzler-Martin Grade IV arteriovenous malformations (AVMs) are challenging due to high risks associated with both treatment and natural progression. This study compares the outcomes of microsurgical resection and stereotactic radiosurgery (SRS) in high-grade AVMs, analyzing obliteration rates, complications, and functional outcomes. A retrospective cohort of 96 patients treated with either microsurgical resection (33 patients) or SRS (63 patients) was analyzed. Propensity-score matching was employed to account for baseline variables such as AVM size (cm), preoperative embolization and rupture status. Primary endpoints included AVM obliteration, complication rates, and modified Rankin Scale (mRS) scores. After matching, 31 patients per group were analyzed. Microsurgical resection achieved significantly higher obliteration rates (87.1%) compared to SRS (32.3%, p < 0.001). In the matched SRS cohort (n = 31), the actuarial obliteration rates were 11% (95% CI: 0-22%) at 1 year, 17% (95% CI: 0-31%) at 3 years, and 43% (95% CI: 13-63%) at 5 years post-treatment. Complication rates were similar (32.3% resection, 38.7% SRS, p = 0.6). Functional outcomes in terms of improvement in modified Rankin Scale (mRS) scores were observed in 50.0% of microsurgery patients and 41.4% of SRS patients. However, the absolute number of patients improving was similar (13 vs. 12), and the microsurgery group had more cases of worsening mRS scores compared to the SRS group (4 vs. 2). The difference was not statistically significant (p = 0.4). Microsurgical resection offers superior obliteration rates for high-grade AVMs with comparable complication risks to SRS. SRS remains a valuable alternative for select patients, particularly those ineligible for resection. Future research should focus on optimizing multimodal treatment approaches. Clinical trial number Not applicable.
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Le contrôle bibliographique ouvert
DOI retrouvé dans Crossref DOI retrouvé ; titre concordant.
- Titre Crossref
- Spetzler-martin grade IV cerebral arteriovenous malformations in adult patients: a propensity-score matched analysis of resection and stereotactic radiosurgery
- Date Crossref
- 31/03/2025
- Éditeur
- Springer Science and Business Media LLC
- Type
- journal-article
Ce recoupement confirme des métadonnées liées au DOI. Il ne confirme ni la méthode ni les conclusions de l’étude, et il ne compte pas comme une seconde source scientifique indépendante.
Où se fait cette recherche
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University of Virginia Department of Neurosurgery pays non établi dans la noticeUniversité ou école supérieure
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Louisiana State University Health Sciences Center Shreveport Department of Radiology pays non établi dans la noticeÉtablissement de santé
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The University of Texas Health Science Center at Houston pays non établi dans la noticeUniversité ou école supérieure
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University of Pennsylvania Department of Neurosurgery pays non établi dans la noticeUniversité ou école supérieure
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Louisiana State University in Shreveport pays non établi dans la noticeUniversité ou école supérieure
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Thomas Jefferson University Hospital Department of Neurosurgery pays non établi dans la noticeÉtablissement de santé
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Beth Israel Deaconess Medical Center Division of Neurosurgery pays non établi dans la noticeÉtablissement de santé
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Harvard University pays non établi dans la noticeUniversité ou école supérieure
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New York University Department of Neurosurgery pays non établi dans la noticeUniversité ou école supérieure
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Massachusetts General Hospital Neuroendovascular Program pays non établi dans la noticeÉtablissement de santé
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University of Miami Department of Neurosurgery pays non établi dans la noticeUniversité ou école supérieure
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University of Wisconsin–Madison pays non établi dans la noticeUniversité ou école supérieure
Department of Neurosurgery — University of Virginia, Department of Radiology — Louisiana State University Health Sciences Center Shreveport et The University of Texas Health Science Center at Houston, avec 9 autres affiliations.
Une affiliation ne permet pas de déduire la nationalité d’un auteur.