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

Salem M Tos; Bardia Hajikarimloo; Mahmoud Osama; Georgios Mantziaris; Nimer Adeeb; Sandeep Kandregula; Hamza Adel Salim; Basel Musmar; Christopher Ogilvy; Douglas Kondziolka; Adam A Dmytriw; Kareem El Naamani; Ahmed Abdelsalam; Deepak Kumbhare; Sanjeev Gummadi; Cagdas Ataoglu; Muhammed Amir Essibayi; Ufuk Erginoglu; Abdullah Keles; Sandeep Muram; Daniel Sconzo; Howard Riina; Arwin Rezai; Johannes Pöppe; Rajeev D Sen; Omar Alwakaa; Christoph J Griessenauer; Pascal Jabbour; Stavropoula I Tjoumakaris; Jan-Karl Burkhardt; Robert M Starke; Mustafa K Baskaya; Laligam N Sekhar; Michael R Levitt; David J Altschul; Neil Haranhalli; Malia McAvoy; Abdallah Abushehab; Assala Aslan; Christian Swaid; Adib Abla; Christopher Stapleton; Matthew Koch; Visish M Srinivasan; Peng R Chen; Spiros Blackburn; Joseph Cochran; Omar Choudhri; Bryan Pukenas; Darren Orbach; Edward Smith; Markus Möhlenbruch; Ali Alaraj; Ali Aziz-Sultan; Kathleen Dlouhy; Tarek El Ahmadieh; Aman B Patel; Amey Savardekar; Hugo H Cuellar; Michael Lawton; Bharat Guthikonda; Jacques Morcos; Jason Sheehan

doi:10.1016/j.clineuro.2024.108669

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

Salem M Tos, Bardia Hajikarimloo, Mahmoud Osama, Georgios Mantziaris, Nimer Adeeb, Sandeep Kandregula, Hamza Adel Salim, Basel Musmar, Christopher Ogilvy, Douglas Kondziolka, Adam A Dmytriw, Kareem El Naamani, Ahmed Abdelsalam, Deepak Kumbhare, Sanjeev Gummadi, Cagdas Ataoglu, Muhammed Amir Essibayi, Ufuk Erginoglu, Abdullah Keles, Sandeep MuramDaniel Sconzo, Howard Riina, Arwin Rezai (Co-author), Johannes Pöppe (Co-author), Rajeev D Sen, Omar Alwakaa, Christoph J Griessenauer (Co-author), Pascal Jabbour, Stavropoula I Tjoumakaris, Jan-Karl Burkhardt, Robert M Starke, Mustafa K Baskaya, Laligam N Sekhar, Michael R Levitt, David J Altschul, Neil Haranhalli, Malia McAvoy, Abdallah Abushehab, Assala Aslan, Christian Swaid, Adib Abla, Christopher Stapleton, Matthew Koch, Visish M Srinivasan, Peng R Chen, Spiros Blackburn, Joseph Cochran, Omar Choudhri, Bryan Pukenas, Darren Orbach, Edward Smith, Markus Möhlenbruch, Ali Alaraj, Ali Aziz-Sultan, Kathleen Dlouhy, Tarek El Ahmadieh, Aman B Patel, Amey Savardekar, Hugo H Cuellar, Michael Lawton, Bharat Guthikonda, Jacques Morcos, Jason Sheehan

Department of Neurosurgery

Research output: Contribution to journal › Original Article › peer-review

Abstract

BACKGROUND: 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.

METHODS: 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.

RESULTS: 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 < 0.001). The median time to obliteration post-SRS was 31.5 months (IQR: 15.3-60.0). SRS obliteration rates were 19 %, 29 %, and 59 % at 24, 36, and 60 months, respectively. Overall complication rates (MS: 30 % vs. SRS: 20 %, p = 0.4) and permanent complications (MS: 10 % vs. SRS: 13.3 %, 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.

CONCLUSION: MS and SRS are viable treatments for SM Grade III BAVMs. Treatment choice should be individualized by a multidisciplinary team, considering patient goals.

Original language	English
Article number	108669
Pages (from-to)	108669
Number of pages	10
Journal	Clinical Neurology and Neurosurgery
Volume	249
Early online date	3 Dec 2024
DOIs	https://doi.org/10.1016/j.clineuro.2024.108669
Publication status	Published - Feb 2025

Access to Document

10.1016/j.clineuro.2024.108669

Cite this

Tos, S. M., Hajikarimloo, B., Osama, M., Mantziaris, G., Adeeb, N., Kandregula, S., Salim, H. A., Musmar, B., Ogilvy, C., Kondziolka, D., Dmytriw, A. A., El Naamani, K., Abdelsalam, A., Kumbhare, D., Gummadi, S., Ataoglu, C., Essibayi, M. A., Erginoglu, U., Keles, A., ... Sheehan, J. (2025). A comparative analysis of microsurgical resection versus stereotactic radiosurgery for Spetzler-Martin grade III arteriovenous malformations: A multicenter propensity score matched study. Clinical Neurology and Neurosurgery, 249, 108669. Article 108669. https://doi.org/10.1016/j.clineuro.2024.108669

@article{de6b452d601847c1965b203056a0a1b0,

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

abstract = "BACKGROUND: 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.METHODS: 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.RESULTS: 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 < 0.001). The median time to obliteration post-SRS was 31.5 months (IQR: 15.3-60.0). SRS obliteration rates were 19 %, 29 %, and 59 % at 24, 36, and 60 months, respectively. Overall complication rates (MS: 30 % vs. SRS: 20 %, p = 0.4) and permanent complications (MS: 10 % vs. SRS: 13.3 %, 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.CONCLUSION: MS and SRS are viable treatments for SM Grade III BAVMs. Treatment choice should be individualized by a multidisciplinary team, considering patient goals.",

author = "Tos, {Salem M} and Bardia Hajikarimloo and Mahmoud Osama and Georgios Mantziaris and Nimer Adeeb and Sandeep Kandregula and Salim, {Hamza Adel} and Basel Musmar and Christopher Ogilvy and Douglas Kondziolka and Dmytriw, {Adam A} and {El Naamani}, Kareem and Ahmed Abdelsalam and Deepak Kumbhare and Sanjeev Gummadi and Cagdas Ataoglu and Essibayi, {Muhammed Amir} and Ufuk Erginoglu and Abdullah Keles and Sandeep Muram and Daniel Sconzo and Howard Riina and Arwin Rezai and Johannes P{\"o}ppe and Sen, {Rajeev D} and Omar Alwakaa and Griessenauer, {Christoph J} and Pascal Jabbour and Tjoumakaris, {Stavropoula I} and Jan-Karl Burkhardt and Starke, {Robert M} and Baskaya, {Mustafa K} and Sekhar, {Laligam N} and Levitt, {Michael R} and Altschul, {David J} and Neil Haranhalli and Malia McAvoy and Abdallah Abushehab and Assala Aslan and Christian Swaid and Adib Abla and Christopher Stapleton and Matthew Koch and Srinivasan, {Visish M} and Chen, {Peng R} and Spiros Blackburn and Joseph Cochran and Omar Choudhri and Bryan Pukenas and Darren Orbach and Edward Smith and Markus M{\"o}hlenbruch and Ali Alaraj and Ali Aziz-Sultan and Kathleen Dlouhy and {El Ahmadieh}, Tarek and Patel, {Aman B} and Amey Savardekar and Cuellar, {Hugo H} and Michael Lawton and Bharat Guthikonda and Jacques Morcos and Jason Sheehan",

note = "Rezai, P{\"o}ppe, Griessenauer: Department of Neurosurgery, Christian Doppler Klinik, Paracelsus Medical University, Salzburg, Austria",

year = "2025",

month = feb,

doi = "10.1016/j.clineuro.2024.108669",

language = "English",

volume = "249",

pages = "108669",

journal = "Clinical Neurology and Neurosurgery",

issn = "0303-8467",

}

Tos, SM, Hajikarimloo, B, Osama, M, Mantziaris, G, Adeeb, N, Kandregula, S, Salim, HA, Musmar, B, Ogilvy, C, Kondziolka, D, Dmytriw, AA, El Naamani, K, Abdelsalam, A, Kumbhare, D, Gummadi, S, Ataoglu, C, Essibayi, MA, Erginoglu, U, Keles, A, Muram, S, Sconzo, D, Riina, H, Rezai, A , Pöppe, J, Sen, RD, Alwakaa, O, Griessenauer, CJ, Jabbour, P, Tjoumakaris, SI, Burkhardt, J-K, Starke, RM, Baskaya, MK, Sekhar, LN, Levitt, MR, Altschul, DJ, Haranhalli, N, McAvoy, M, Abushehab, A, Aslan, A, Swaid, C, Abla, A, Stapleton, C, Koch, M, Srinivasan, VM, Chen, PR, Blackburn, S, Cochran, J, Choudhri, O, Pukenas, B, Orbach, D, Smith, E, Möhlenbruch, M, Alaraj, A, Aziz-Sultan, A, Dlouhy, K, El Ahmadieh, T, Patel, AB, Savardekar, A, Cuellar, HH, Lawton, M, Guthikonda, B, Morcos, J & Sheehan, J 2025, 'A comparative analysis of microsurgical resection versus stereotactic radiosurgery for Spetzler-Martin grade III arteriovenous malformations: A multicenter propensity score matched study', Clinical Neurology and Neurosurgery, vol. 249, 108669, pp. 108669. https://doi.org/10.1016/j.clineuro.2024.108669

A comparative analysis of microsurgical resection versus stereotactic radiosurgery for Spetzler-Martin grade III arteriovenous malformations: A multicenter propensity score matched study. / Tos, Salem M; Hajikarimloo, Bardia; Osama, Mahmoud et al.
In: Clinical Neurology and Neurosurgery, Vol. 249, 108669, 02.2025, p. 108669.

Research output: Contribution to journal › Original Article › peer-review

TY - JOUR

T1 - A comparative analysis of microsurgical resection versus stereotactic radiosurgery for Spetzler-Martin grade III arteriovenous malformations

T2 - A multicenter propensity score matched study

AU - Tos, Salem M

AU - Hajikarimloo, Bardia

AU - Osama, Mahmoud

AU - Mantziaris, Georgios

AU - Adeeb, Nimer

AU - Kandregula, Sandeep

AU - Salim, Hamza Adel

AU - Musmar, Basel

AU - Ogilvy, Christopher

AU - Kondziolka, Douglas

AU - Dmytriw, Adam A

AU - El Naamani, Kareem

AU - Abdelsalam, Ahmed

AU - Kumbhare, Deepak

AU - Gummadi, Sanjeev

AU - Ataoglu, Cagdas

AU - Essibayi, Muhammed Amir

AU - Erginoglu, Ufuk

AU - Keles, Abdullah

AU - Muram, Sandeep

AU - Sconzo, Daniel

AU - Riina, Howard

AU - Rezai, Arwin

AU - Pöppe, Johannes

AU - Sen, Rajeev D

AU - Alwakaa, Omar

AU - Griessenauer, Christoph J

AU - Jabbour, Pascal

AU - Tjoumakaris, Stavropoula I

AU - Burkhardt, Jan-Karl

AU - Starke, Robert M

AU - Baskaya, Mustafa K

AU - Sekhar, Laligam N

AU - Levitt, Michael R

AU - Altschul, David J

AU - Haranhalli, Neil

AU - McAvoy, Malia

AU - Abushehab, Abdallah

AU - Aslan, Assala

AU - Swaid, Christian

AU - Abla, Adib

AU - Stapleton, Christopher

AU - Koch, Matthew

AU - Srinivasan, Visish M

AU - Chen, Peng R

AU - Blackburn, Spiros

AU - Cochran, Joseph

AU - Choudhri, Omar

AU - Pukenas, Bryan

AU - Orbach, Darren

AU - Smith, Edward

AU - Möhlenbruch, Markus

AU - Alaraj, Ali

AU - Aziz-Sultan, Ali

AU - Dlouhy, Kathleen

AU - El Ahmadieh, Tarek

AU - Patel, Aman B

AU - Savardekar, Amey

AU - Cuellar, Hugo H

AU - Lawton, Michael

AU - Guthikonda, Bharat

AU - Morcos, Jacques

AU - Sheehan, Jason

N1 - Rezai, Pöppe, Griessenauer: Department of Neurosurgery, Christian Doppler Klinik, Paracelsus Medical University, Salzburg, Austria

PY - 2025/2

Y1 - 2025/2

N2 - BACKGROUND: 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.METHODS: 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.RESULTS: 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 < 0.001). The median time to obliteration post-SRS was 31.5 months (IQR: 15.3-60.0). SRS obliteration rates were 19 %, 29 %, and 59 % at 24, 36, and 60 months, respectively. Overall complication rates (MS: 30 % vs. SRS: 20 %, p = 0.4) and permanent complications (MS: 10 % vs. SRS: 13.3 %, 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.CONCLUSION: MS and SRS are viable treatments for SM Grade III BAVMs. Treatment choice should be individualized by a multidisciplinary team, considering patient goals.

AB - BACKGROUND: 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.METHODS: 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.RESULTS: 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 < 0.001). The median time to obliteration post-SRS was 31.5 months (IQR: 15.3-60.0). SRS obliteration rates were 19 %, 29 %, and 59 % at 24, 36, and 60 months, respectively. Overall complication rates (MS: 30 % vs. SRS: 20 %, p = 0.4) and permanent complications (MS: 10 % vs. SRS: 13.3 %, 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.CONCLUSION: MS and SRS are viable treatments for SM Grade III BAVMs. Treatment choice should be individualized by a multidisciplinary team, considering patient goals.

U2 - 10.1016/j.clineuro.2024.108669

DO - 10.1016/j.clineuro.2024.108669

M3 - Original Article

C2 - 39642799

SN - 0303-8467

VL - 249

SP - 108669

JO - Clinical Neurology and Neurosurgery

JF - Clinical Neurology and Neurosurgery

M1 - 108669

ER -

Tos SM, Hajikarimloo B, Osama M, Mantziaris G, Adeeb N, Kandregula S et al. A comparative analysis of microsurgical resection versus stereotactic radiosurgery for Spetzler-Martin grade III arteriovenous malformations: A multicenter propensity score matched study. Clinical Neurology and Neurosurgery. 2025 Feb;249:108669. 108669. Epub 2024 Dec 3. doi: 10.1016/j.clineuro.2024.108669

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

Abstract

Access to Document

Fingerprint

Cite this