Spetzler-Martin grade I and II cerebral arteriovenous malformations: a propensity-score matched analysis of resection and stereotactic radiosurgery in adult patients.

Cerebral arteriovenous malformations (AVMs) are congenital vascular anomalies that can lead to severe complications, including hemorrhage and neurological deficits. This study compares the outcomes of microsurgical resection and stereotactic radiosurgery (SRS) for SM grade I and II AVMs. Out of a large multicenter registry, we identified 180 matched patients with SM grade I and II AVMs treated with either microsurgical resection or SRS between 2010 and 2023. The primary outcomes were AVM obliteration rates and complications; secondary outcomes included neurological status and functional outcomes measured by the modified Rankin Scale (mRS). Propensity score matching (PSM) was utilized to ensure comparability between treatment groups. After PSM, 90 patients were allocated to each treatment group. Significant differences were observed in complete obliteration rates, with resection achieving higher rates compared to SRS in overall cases (97.8% vs. 60.0%, p < 0.001), unruptured AVMs (100% vs. 58.3%, p < 0.001), and ruptured AVMs (95.2% vs. 61.9%, p < 0.001). Functional improvement rates were similar between the groups for overall cases (67.2% in resection vs. 66.7% in SRS, p = 0.95), unruptured AVMs (55.2% in resection vs. 55.6% in SRS, p > 0.9), and ruptured AVMs (78.1% in resection vs. 74.1% in SRS, p = 0.7). Symptomatic complication rates were identical between the groups (11.1% each, p > 0.9), while permanent complication rates were comparable (6.7% in resection vs. 5.6% in SRS, p = 0.8). Resection demonstrated significantly higher complete obliteration rates compared to SRS across all cases, including unruptured and ruptured AVMs. Functional improvement rates were similar between the two treatment groups, with no significant differences in symptomatic or permanent complication rates.
Competing Interests: Declarations. Ethical approval: This retrospective multicenter clinical cohort study was conducted in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards. The study protocol was reviewed and approved by the Institutional Review Board (IRB) of University of Virginia Hospital. Due to the retrospective nature of the study, the requirement for informed consent was waived by the IRB. All patient data were anonymized and de-identified prior to analysis to ensure patient confidentiality. Conflict of interest: The researchers reported that there was no conflict of interest Disclosure: Dr. Griessenauer reported personal fees from MicroVention and Stryker, proctoring for Medtronic, and grants from Penumbra and Baxter outside the submitted work. Dr. Tjoumakaris reported being a consultant for MicroVention. Dr. Burkhardt reported being a consultant for MicroVention, Stryker, Q’Apel, Cerenovos, and Longeviti Neuro Solutions outside the submitted work. Dr. Möhlenbruch reported grants from Balt, MicroVention, Medtronic, and Stryker outside the submitted work. A. B. Patel reported personal fees from MicroVention, Medtronic, and Penumbra outside the submitted work.Dr. Cuellar reported being a consultant for MicroVention. The rest of authors declared no personal, financial, or institutional interests related to the drugs, materials, or devices discussed in the article. Consent to participate: The study was approved by institutional review boards, with waived informed consent due to its retrospective design. Data was de-identified for confidentiality. Clinical trial number: Not applicable.
(© 2025. The Author(s).)