Efficacy and safety of preoperative embolization in surgical treatment of brain arteriovenous malformations: a multicentre study with propensity score matching

Hamza Salim; Dawoud Hamdan; Nimer Adeeb; Sandeep Kandregula; Assala Aslan; Basel Musmar; Christopher S. Ogilvy; Adam A. Dmytriw; Ahmed Abdelsalam; Cagdas Ataoglu; Ufuk Erginoglu; Douglas Kondziolka; Kareem El Naamani; Jason Sheehan; Natasha Ironside; Deepak Kumbhare; Sanjeev Gummadi; Muhammed Amir Essibayi; Salem M. Tos; Abdullah Keles; Sandeep Muram; Daniel Sconzo; Arwin Rezai; Omar Alwakaa; Johannes Poeppe; Rajeev D. Sen; Mustafa K. Baskaya; Christoph J. Griessenauer; Pascal Jabbour; Stavropoula Tjoumakaris; Elias Atallah; Howard Riina; Abdallah Abushehab; Christian Swaid; Jan-Karl Burkhardt; Robert M. Starke; Laligam N. Sekhar; Michael R. Levitt; David J. Altschul; Neil Haranhalli; Malia Mcavoy; Adib Abla; Christopher Stapleton; Matthew J. Koch; Visish M. Srinivasan; Peng Roc Chen; Spiros Blackburn; Joseph Cochran; Omar Choudhri; Bryan Pukenas; Darren B. Orbach; Edward R. Smith; Markus Moehlenbruch; Pascal J. Mosimann; Ali Alaraj; Mohammad Ali Aziz-Sultan; Aman B. Patel; Vivek Yedavalli; Max Wintermark; Amey Savardekar; Hugo H. Cuellar; Michael T. Lawton; Jacques J. Morcos; Bharat Guthikonda

doi:10.1136/jnnp-2024-334974

Efficacy and safety of preoperative embolization in surgical treatment of brain arteriovenous malformations: a multicentre study with propensity score matching

Hamza Salim, Dawoud Hamdan, Nimer Adeeb, Sandeep Kandregula, Assala Aslan, Basel Musmar, Christopher S. Ogilvy, Adam A. Dmytriw, Ahmed Abdelsalam, Cagdas Ataoglu, Ufuk Erginoglu, Douglas Kondziolka, Kareem El Naamani, Jason Sheehan, Natasha Ironside, Deepak Kumbhare, Sanjeev Gummadi, Muhammed Amir Essibayi, Salem M. Tos, Abdullah KelesSandeep Muram, Daniel Sconzo, Arwin Rezai (Co-author), Omar Alwakaa, Johannes Poeppe (Co-author), Rajeev D. Sen, Mustafa K. Baskaya, Christoph J. Griessenauer (Co-author), Pascal Jabbour, Stavropoula Tjoumakaris, Elias Atallah, Howard Riina, Abdallah Abushehab, Christian Swaid, Jan-Karl Burkhardt, Robert M. Starke, Laligam N. Sekhar, Michael R. Levitt, David J. Altschul, Neil Haranhalli, Malia Mcavoy, Adib Abla, Christopher Stapleton, Matthew J. Koch, Visish M. Srinivasan, Peng Roc Chen, Spiros Blackburn, Joseph Cochran, Omar Choudhri, Bryan Pukenas, Darren B. Orbach, Edward R. Smith, Markus Moehlenbruch, Pascal J. Mosimann, Ali Alaraj, Mohammad Ali Aziz-Sultan, Aman B. Patel, Vivek Yedavalli, Max Wintermark, Amey Savardekar, Hugo H. Cuellar, Michael T. Lawton, Jacques J. Morcos, Bharat Guthikonda

Department of Neurosurgery

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

1 Citation (Web of Science)

Abstract

Background Brain arteriovenous malformations (AVMs) are abnormal connections between feeding arteries and draining veins, associated with significant risks of haemorrhage, seizures and other neurological deficits. Preoperative embolization is commonly used as an adjunct to microsurgical resection, with the aim of reducing intraoperative complications and improving outcomes. However, the efficacy and safety of this approach remain controversial.Methods This study is a subanalysis of the Multicenter International Study for Treatment of Brain AVMs consortium. We retrospectively analysed 486 patients with brain AVMs treated with microsurgical resection between January 2010 and December 2023. Patients were divided into two groups: those who underwent microsurgery alone (n=245) and those who received preoperative embolization, followed by microsurgery (n=241). Propensity score matching was employed, resulting in 288 matched patients (144 in each group). The primary outcomes were rates of complete AVM obliteration and functional outcomes (measured by the modified Rankin Scale (mRS)). Secondary outcomes included complication rates, mortality, hospital length of stay and postsurgical rupture.Results After matching, the complete obliteration rate was 97% with no significant difference between the microsurgery-only group and the preoperative embolization group (p=0.12). The proportion of patients with an mRS score of 0-2 at the last follow-up was similar in both groups (83% vs 84%; p=0.67). The median hospital stay was significantly longer for the embolisation group (9 days vs 7 days; p=0.017). Complication rates (24% vs 22%; p=0.57) and mortality rates (4.9% vs 2.1%; p=0.20) were comparable between the two groups. No significant differences were observed in postsurgical rupture, recurrence or retreatment rates.Conclusions In this large multicentre study, preoperative embolization did not significantly improve AVM obliteration rates, functional outcomes or reduce complications compared with microsurgery alone.

Original language	English
Number of pages	9
Journal	JOURNAL OF NEUROLOGY NEUROSURGERY AND PSYCHIATRY
Early online date	Feb 2025
DOIs	https://doi.org/10.1136/jnnp-2024-334974
Publication status	Published - 6 Feb 2025

Keywords

Cerebrovascular

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10.1136/jnnp-2024-334974

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Salim, H., Hamdan, D., Adeeb, N., Kandregula, S., Aslan, A., Musmar, B., Ogilvy, C. S., Dmytriw, A. A., Abdelsalam, A., Ataoglu, C., Erginoglu, U., Kondziolka, D., El Naamani, K., Sheehan, J., Ironside, N., Kumbhare, D., Gummadi, S., Essibayi, M. A., Tos, S. M., ... Guthikonda, B. (2025). Efficacy and safety of preoperative embolization in surgical treatment of brain arteriovenous malformations: a multicentre study with propensity score matching. JOURNAL OF NEUROLOGY NEUROSURGERY AND PSYCHIATRY https://doi.org/10.1136/jnnp-2024-334974

Salim, Hamza ; Hamdan, Dawoud ; Adeeb, Nimer et al. / Efficacy and safety of preoperative embolization in surgical treatment of brain arteriovenous malformations : a multicentre study with propensity score matching. In: JOURNAL OF NEUROLOGY NEUROSURGERY AND PSYCHIATRY 2025.

@article{cbfd91673155403b81c9353ab3226af6,

title = "Efficacy and safety of preoperative embolization in surgical treatment of brain arteriovenous malformations: a multicentre study with propensity score matching",

abstract = "Background Brain arteriovenous malformations (AVMs) are abnormal connections between feeding arteries and draining veins, associated with significant risks of haemorrhage, seizures and other neurological deficits. Preoperative embolization is commonly used as an adjunct to microsurgical resection, with the aim of reducing intraoperative complications and improving outcomes. However, the efficacy and safety of this approach remain controversial.Methods This study is a subanalysis of the Multicenter International Study for Treatment of Brain AVMs consortium. We retrospectively analysed 486 patients with brain AVMs treated with microsurgical resection between January 2010 and December 2023. Patients were divided into two groups: those who underwent microsurgery alone (n=245) and those who received preoperative embolization, followed by microsurgery (n=241). Propensity score matching was employed, resulting in 288 matched patients (144 in each group). The primary outcomes were rates of complete AVM obliteration and functional outcomes (measured by the modified Rankin Scale (mRS)). Secondary outcomes included complication rates, mortality, hospital length of stay and postsurgical rupture.Results After matching, the complete obliteration rate was 97\% with no significant difference between the microsurgery-only group and the preoperative embolization group (p=0.12). The proportion of patients with an mRS score of 0-2 at the last follow-up was similar in both groups (83\% vs 84\%; p=0.67). The median hospital stay was significantly longer for the embolisation group (9 days vs 7 days; p=0.017). Complication rates (24\% vs 22\%; p=0.57) and mortality rates (4.9\% vs 2.1\%; p=0.20) were comparable between the two groups. No significant differences were observed in postsurgical rupture, recurrence or retreatment rates.Conclusions In this large multicentre study, preoperative embolization did not significantly improve AVM obliteration rates, functional outcomes or reduce complications compared with microsurgery alone.",

keywords = "Cerebrovascular",

author = "Hamza Salim and Dawoud Hamdan and Nimer Adeeb and Sandeep Kandregula and Assala Aslan and Basel Musmar and Ogilvy, \{Christopher S.\} and Dmytriw, \{Adam A.\} and Ahmed Abdelsalam and Cagdas Ataoglu and Ufuk Erginoglu and Douglas Kondziolka and \{El Naamani\}, Kareem and Jason Sheehan and Natasha Ironside and Deepak Kumbhare and Sanjeev Gummadi and Essibayi, \{Muhammed Amir\} and Tos, \{Salem M.\} and Abdullah Keles and Sandeep Muram and Daniel Sconzo and Arwin Rezai and Omar Alwakaa and Johannes Poeppe and Sen, \{Rajeev D.\} and Baskaya, \{Mustafa K.\} and Griessenauer, \{Christoph J.\} and Pascal Jabbour and Stavropoula Tjoumakaris and Elias Atallah and Howard Riina and Abdallah Abushehab and Christian Swaid and Jan-Karl Burkhardt and Starke, \{Robert M.\} and Sekhar, \{Laligam N.\} and Levitt, \{Michael R.\} and Altschul, \{David J.\} and Neil Haranhalli and Malia Mcavoy and Adib Abla and Christopher Stapleton and Koch, \{Matthew J.\} and Srinivasan, \{Visish M.\} and Chen, \{Peng Roc\} and Spiros Blackburn and Joseph Cochran and Omar Choudhri and Bryan Pukenas and Orbach, \{Darren B.\} and Smith, \{Edward R.\} and Markus Moehlenbruch and Mosimann, \{Pascal J.\} and Ali Alaraj and Aziz-Sultan, \{Mohammad Ali\} and Patel, \{Aman B.\} and Vivek Yedavalli and Max Wintermark and Amey Savardekar and Cuellar, \{Hugo H.\} and Lawton, \{Michael T.\} and Morcos, \{Jacques J.\} and Bharat Guthikonda",

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

year = "2025",

month = feb,

day = "6",

doi = "10.1136/jnnp-2024-334974",

language = "English",

journal = "JOURNAL OF NEUROLOGY NEUROSURGERY AND PSYCHIATRY ",

issn = "0022-3050",

publisher = "Bmj Publishing Group",

}

Salim, H, Hamdan, D, Adeeb, N, Kandregula, S, Aslan, A, Musmar, B, Ogilvy, CS, Dmytriw, AA, Abdelsalam, A, Ataoglu, C, Erginoglu, U, Kondziolka, D, El Naamani, K, Sheehan, J, Ironside, N, Kumbhare, D, Gummadi, S, Essibayi, MA, Tos, SM, Keles, A, Muram, S, Sconzo, D, Rezai, A, Alwakaa, O, Poeppe, J, Sen, RD, Baskaya, MK, Griessenauer, CJ, Jabbour, P, Tjoumakaris, S, Atallah, E, Riina, H, Abushehab, A, Swaid, C, Burkhardt, J-K, Starke, RM, Sekhar, LN, Levitt, MR, Altschul, DJ, Haranhalli, N, Mcavoy, M, Abla, A, Stapleton, C, Koch, MJ, Srinivasan, VM, Chen, PR, Blackburn, S, Cochran, J, Choudhri, O, Pukenas, B, Orbach, DB, Smith, ER, Moehlenbruch, M, Mosimann, PJ, Alaraj, A, Aziz-Sultan, MA, Patel, AB, Yedavalli, V, Wintermark, M, Savardekar, A, Cuellar, HH, Lawton, MT, Morcos, JJ & Guthikonda, B 2025, 'Efficacy and safety of preoperative embolization in surgical treatment of brain arteriovenous malformations: a multicentre study with propensity score matching', JOURNAL OF NEUROLOGY NEUROSURGERY AND PSYCHIATRY https://doi.org/10.1136/jnnp-2024-334974

Efficacy and safety of preoperative embolization in surgical treatment of brain arteriovenous malformations: a multicentre study with propensity score matching. / Salim, Hamza; Hamdan, Dawoud; Adeeb, Nimer et al.
In: JOURNAL OF NEUROLOGY NEUROSURGERY AND PSYCHIATRY , 06.02.2025.

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

TY - JOUR

T1 - Efficacy and safety of preoperative embolization in surgical treatment of brain arteriovenous malformations

T2 - a multicentre study with propensity score matching

AU - Salim, Hamza

AU - Hamdan, Dawoud

AU - Adeeb, Nimer

AU - Kandregula, Sandeep

AU - Aslan, Assala

AU - Musmar, Basel

AU - Ogilvy, Christopher S.

AU - Dmytriw, Adam A.

AU - Abdelsalam, Ahmed

AU - Ataoglu, Cagdas

AU - Erginoglu, Ufuk

AU - Kondziolka, Douglas

AU - El Naamani, Kareem

AU - Sheehan, Jason

AU - Ironside, Natasha

AU - Kumbhare, Deepak

AU - Gummadi, Sanjeev

AU - Essibayi, Muhammed Amir

AU - Tos, Salem M.

AU - Keles, Abdullah

AU - Muram, Sandeep

AU - Sconzo, Daniel

AU - Rezai, Arwin

AU - Alwakaa, Omar

AU - Poeppe, Johannes

AU - Sen, Rajeev D.

AU - Baskaya, Mustafa K.

AU - Griessenauer, Christoph J.

AU - Jabbour, Pascal

AU - Tjoumakaris, Stavropoula

AU - Atallah, Elias

AU - Riina, Howard

AU - Abushehab, Abdallah

AU - Swaid, Christian

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 - Abla, Adib

AU - Stapleton, Christopher

AU - Koch, Matthew J.

AU - Srinivasan, Visish M.

AU - Chen, Peng Roc

AU - Blackburn, Spiros

AU - Cochran, Joseph

AU - Choudhri, Omar

AU - Pukenas, Bryan

AU - Orbach, Darren B.

AU - Smith, Edward R.

AU - Moehlenbruch, Markus

AU - Mosimann, Pascal J.

AU - Alaraj, Ali

AU - Aziz-Sultan, Mohammad Ali

AU - Patel, Aman B.

AU - Yedavalli, Vivek

AU - Wintermark, Max

AU - Savardekar, Amey

AU - Cuellar, Hugo H.

AU - Lawton, Michael T.

AU - Morcos, Jacques J.

AU - Guthikonda, Bharat

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

PY - 2025/2/6

Y1 - 2025/2/6

N2 - Background Brain arteriovenous malformations (AVMs) are abnormal connections between feeding arteries and draining veins, associated with significant risks of haemorrhage, seizures and other neurological deficits. Preoperative embolization is commonly used as an adjunct to microsurgical resection, with the aim of reducing intraoperative complications and improving outcomes. However, the efficacy and safety of this approach remain controversial.Methods This study is a subanalysis of the Multicenter International Study for Treatment of Brain AVMs consortium. We retrospectively analysed 486 patients with brain AVMs treated with microsurgical resection between January 2010 and December 2023. Patients were divided into two groups: those who underwent microsurgery alone (n=245) and those who received preoperative embolization, followed by microsurgery (n=241). Propensity score matching was employed, resulting in 288 matched patients (144 in each group). The primary outcomes were rates of complete AVM obliteration and functional outcomes (measured by the modified Rankin Scale (mRS)). Secondary outcomes included complication rates, mortality, hospital length of stay and postsurgical rupture.Results After matching, the complete obliteration rate was 97% with no significant difference between the microsurgery-only group and the preoperative embolization group (p=0.12). The proportion of patients with an mRS score of 0-2 at the last follow-up was similar in both groups (83% vs 84%; p=0.67). The median hospital stay was significantly longer for the embolisation group (9 days vs 7 days; p=0.017). Complication rates (24% vs 22%; p=0.57) and mortality rates (4.9% vs 2.1%; p=0.20) were comparable between the two groups. No significant differences were observed in postsurgical rupture, recurrence or retreatment rates.Conclusions In this large multicentre study, preoperative embolization did not significantly improve AVM obliteration rates, functional outcomes or reduce complications compared with microsurgery alone.

AB - Background Brain arteriovenous malformations (AVMs) are abnormal connections between feeding arteries and draining veins, associated with significant risks of haemorrhage, seizures and other neurological deficits. Preoperative embolization is commonly used as an adjunct to microsurgical resection, with the aim of reducing intraoperative complications and improving outcomes. However, the efficacy and safety of this approach remain controversial.Methods This study is a subanalysis of the Multicenter International Study for Treatment of Brain AVMs consortium. We retrospectively analysed 486 patients with brain AVMs treated with microsurgical resection between January 2010 and December 2023. Patients were divided into two groups: those who underwent microsurgery alone (n=245) and those who received preoperative embolization, followed by microsurgery (n=241). Propensity score matching was employed, resulting in 288 matched patients (144 in each group). The primary outcomes were rates of complete AVM obliteration and functional outcomes (measured by the modified Rankin Scale (mRS)). Secondary outcomes included complication rates, mortality, hospital length of stay and postsurgical rupture.Results After matching, the complete obliteration rate was 97% with no significant difference between the microsurgery-only group and the preoperative embolization group (p=0.12). The proportion of patients with an mRS score of 0-2 at the last follow-up was similar in both groups (83% vs 84%; p=0.67). The median hospital stay was significantly longer for the embolisation group (9 days vs 7 days; p=0.017). Complication rates (24% vs 22%; p=0.57) and mortality rates (4.9% vs 2.1%; p=0.20) were comparable between the two groups. No significant differences were observed in postsurgical rupture, recurrence or retreatment rates.Conclusions In this large multicentre study, preoperative embolization did not significantly improve AVM obliteration rates, functional outcomes or reduce complications compared with microsurgery alone.

KW - Cerebrovascular

UR - https://www.webofscience.com/api/gateway?GWVersion=2&SrcApp=pmu_pure&SrcAuth=WosAPI&KeyUT=WOS:001419673700001&DestLinkType=FullRecord&DestApp=WOS_CPL

U2 - 10.1136/jnnp-2024-334974

DO - 10.1136/jnnp-2024-334974

M3 - Original Article

C2 - 39915091

SN - 0022-3050

JO - JOURNAL OF NEUROLOGY NEUROSURGERY AND PSYCHIATRY

JF - JOURNAL OF NEUROLOGY NEUROSURGERY AND PSYCHIATRY

ER -

Salim H, Hamdan D, Adeeb N, Kandregula S, Aslan A, Musmar B et al. Efficacy and safety of preoperative embolization in surgical treatment of brain arteriovenous malformations: a multicentre study with propensity score matching. JOURNAL OF NEUROLOGY NEUROSURGERY AND PSYCHIATRY . 2025 Feb 6. Epub 2025 Feb. doi: 10.1136/jnnp-2024-334974

Efficacy and safety of preoperative embolization in surgical treatment of brain arteriovenous malformations: a multicentre study with propensity score matching

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