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Endovascular treatment as first-line therapy in Spetzler-Martin grade III brain arteriovenous malformations: a multicenter retrospective study

Authors :
Julien Burel
Chrysanthi Papagiannaki
Nader Sourour
Atika Talbi
Matthieu Garnier
Capucine Hermary
Maichael Talaat
Anne-Laure Boch
Aurélien Nouet
Stéphanie Lenck
Kévin Premat
Eimad Shotar
Frédéric Clarençon
Source :
Journal of Neurosurgery. :1-8
Publication Year :
2023
Publisher :
Journal of Neurosurgery Publishing Group (JNSPG), 2023.

Abstract

OBJECTIVE The management of Spetzler-Martin grade (SMG) III brain arteriovenous malformations (bAVMs) may be challenging, whatever the exclusion treatment modality chosen. The purpose of this study was to evaluate the safety and effectiveness of endovascular treatment (EVT) as a first-line treatment of SMG III bAVMs. METHODS The authors performed a retrospective, two-center, observational cohort study. Cases recorded in institutional databases between January 1998 and June 2021 were reviewed. Patients who were ≥ 18 years of age, had ruptured or unruptured SMG III bAVMs, and received EVT as first-line therapy were included. Baseline characteristics of patients and bAVMs, procedure-related complications, clinical outcome according to the modified Rankin Scale, and angiographic follow-up were assessed. The independent risk factors of procedure-related complications and poor clinical outcome were assessed using binary logistic regression. RESULTS One hundred sixteen patients with 116 SMG III bAVMs were included. The mean age of the patients was 41.9 ± 14.0 years. The most common presentation was hemorrhage (66.4%). Forty-nine (42.2%) bAVMs were found to be completely obliterated by EVT alone at follow-up. Complications occurred in 39 patients (33.6%), including 5 (4.3%) major procedure-related complications. There was no independent predictor of procedure-related complication. Age > 40 years and poor preoperative modified Rankin Scale score were the independent predictors of poor clinical outcome. CONCLUSIONS EVT of SMG III bAVMs provides encouraging results but needs further improvement. When the embolization procedure performed with intent to cure appears difficult and/or risky, a combined technique (with microsurgery or radiosurgery) may be a safer and more effective strategy. In terms of safety and effectiveness, the benefit of EVT (alone or included in a multimodal management strategy) for SMG III bAVMs needs to be confirmed by randomized controlled trials.

Subjects

Subjects :
General Medicine

Details

ISSN :
19330693 and 00223085
Database :
OpenAIRE
Journal :
Journal of Neurosurgery
Accession number :
edsair.doi...........df29fb4043f9894074f7415b4c4e6ddf
Full Text :
https://doi.org/10.3171/2023.1.jns222745