TY - JOUR
T1 - Comparative outcomes of arteriovenous malformations treatment in eloquent versus non-eloquent brain
T2 - A multicenter study with propensity-score weighting
AU - Musmar, Basel
AU - Adeeb, Nimer
AU - Abdalrazeq, Hammam
AU - Salim, Hamza Adel
AU - Roy, Joanna M.
AU - Aslan, Assala
AU - Tjoumakaris, Stavropoula I.
AU - Ogilvy, Christopher S.
AU - Baskaya, Mustafa K.
AU - Kondziolka, Douglas
AU - Sheehan, Jason
AU - Riina, Howard
AU - Kandregula, Sandeep
AU - Dmytriw, Adam A.
AU - Abushehab, Abdallah
AU - El Naamani, Kareem
AU - Abdelsalam, Ahmed
AU - Ironside, Natasha
AU - Kumbhare, Deepak
AU - Gummadi, Sanjeev
AU - Ataoglu, Cagdas
AU - Essibayi, Muhammed Amir
AU - Keles, Abdullah
AU - Muram, Sandeep
AU - Sconzo, Daniel
AU - Rezai, Arwin
AU - Alwakaa, Omar
AU - Tos, Salem M.
AU - Mantziaris, Georgios
AU - Park, Min S.
AU - Hanalioglu, Sahin
AU - Erginoglu, Ufuk
AU - Poppe, Johannes
AU - Sen, Rajeev D.
AU - Griessenauer, Christoph J.
AU - Burkhardt, Jan-Karl
AU - Starke, Robert M.
AU - Sekhar, Laligam N.
AU - Levitt, Michael R.
AU - Altschul, David J.
AU - Haranhalli, Neil
AU - McAvoy, Malia
AU - Zeineddine, Hussein A.
AU - Abla, Adib A.
AU - Atallah, Elias
AU - Gooch, Michael Reid
AU - Rosenwasser, Robert H.
AU - Stapleton, Christopher
AU - Koch, Matthew
AU - Srinivasan, Visish M.
N1 - Rezai, Pöppe, Griessenauer: Department of Neurosurgery, Christian Doppler Klinik, Paracelsus Medical University, Salzburg, Austria
PY - 2025/8
Y1 - 2025/8
N2 - Background: Arteriovenous malformations (AVMs) are complex vascular anomalies with a high risk of hemorrhage and neurological deficits, especially when located in eloquent brain regions. The eloquence of an AVM location is a critical factor in the treatment planning, influencing both the risk of complications and long-term functional outcomes. This study aims to compare outcomes between eloquent and non-eloquent AVMs.Methods: This multicenter, retrospective study utilized data from the Multicenter International Study for Treatment of Brain AVMs (MISTA) consortium. Patients with eloquent and non-eloquent AVMs were compared on baseline characteristics, angiographic outcomes, and functional outcomes using the modified Rankin Scale (mRS). Propensity score weighting (IPTW) was applied to adjust for confounding variables.Results: The study included 1013 patients, with 498 (49.2%) AVMs located in eloquent regions and 515 (50.8%) in non-eloquent regions. In unadjusted analysis, eloquent AVMs had lower complete obliteration rates (67.6% vs 79.5%, OR: 0.53, 95% CI: 0.39-0.72, p < 0.001) and higher complication rates (24.5% vs 19.0%, OR: 1.38, 95% CI: 1.02-1.86, p = 0.03) compared to non-eloquent AVMs. After IPTW adjustment, eloquent AVMs continued to show significantly higher odds of overall complications (OR: 1.68, 95% CI: 1.12-2.52, p = 0.01) and symptomatic complications (OR: 1.77, 95% CI: 1.12-2.80, p = 0.01). Secondary analysis within the eloquent group indicated that embolization was linked to an elevated risk of complications. Surgery and radiosurgery showed comparable functional outcomes at last follow-up and complications rates with higher complete obliteration rates in surgery.Conclusion: AVMs in eloquent brain areas present higher risks of complications and lower obliteration rates, emphasizing the need for cautious, individualized treatment planning. Within the eloquent group, embolization increased the risk of complications, while surgery and radiosurgery showed comparable functional outcomes at last follow-up and complication rates with higher complete obliteration rates in surgery. These findings highlight the importance of location in AVM management and support further research focusing on comparing treatment strategies for AVMs in eloquent brain areas.
AB - Background: Arteriovenous malformations (AVMs) are complex vascular anomalies with a high risk of hemorrhage and neurological deficits, especially when located in eloquent brain regions. The eloquence of an AVM location is a critical factor in the treatment planning, influencing both the risk of complications and long-term functional outcomes. This study aims to compare outcomes between eloquent and non-eloquent AVMs.Methods: This multicenter, retrospective study utilized data from the Multicenter International Study for Treatment of Brain AVMs (MISTA) consortium. Patients with eloquent and non-eloquent AVMs were compared on baseline characteristics, angiographic outcomes, and functional outcomes using the modified Rankin Scale (mRS). Propensity score weighting (IPTW) was applied to adjust for confounding variables.Results: The study included 1013 patients, with 498 (49.2%) AVMs located in eloquent regions and 515 (50.8%) in non-eloquent regions. In unadjusted analysis, eloquent AVMs had lower complete obliteration rates (67.6% vs 79.5%, OR: 0.53, 95% CI: 0.39-0.72, p < 0.001) and higher complication rates (24.5% vs 19.0%, OR: 1.38, 95% CI: 1.02-1.86, p = 0.03) compared to non-eloquent AVMs. After IPTW adjustment, eloquent AVMs continued to show significantly higher odds of overall complications (OR: 1.68, 95% CI: 1.12-2.52, p = 0.01) and symptomatic complications (OR: 1.77, 95% CI: 1.12-2.80, p = 0.01). Secondary analysis within the eloquent group indicated that embolization was linked to an elevated risk of complications. Surgery and radiosurgery showed comparable functional outcomes at last follow-up and complications rates with higher complete obliteration rates in surgery.Conclusion: AVMs in eloquent brain areas present higher risks of complications and lower obliteration rates, emphasizing the need for cautious, individualized treatment planning. Within the eloquent group, embolization increased the risk of complications, while surgery and radiosurgery showed comparable functional outcomes at last follow-up and complication rates with higher complete obliteration rates in surgery. These findings highlight the importance of location in AVM management and support further research focusing on comparing treatment strategies for AVMs in eloquent brain areas.
KW - Avm
KW - Eloquent
KW - Psw
KW - Multicenter
KW - Non-eloquent
KW - Treatment
UR - https://www.webofscience.com/api/gateway?GWVersion=2&SrcApp=pmu_pure&SrcAuth=WosAPI&KeyUT=WOS:001453135500001&DestLinkType=FullRecord&DestApp=WOS_CPL
U2 - 10.1177/17474930251323503
DO - 10.1177/17474930251323503
M3 - Original Article
C2 - 39948730
SN - 1747-4930
VL - 20
SP - 852
EP - 863
JO - INTERNATIONAL JOURNAL OF STROKE
JF - INTERNATIONAL JOURNAL OF STROKE
IS - 7
ER -