Microsurgery alone versus preoperative embolisation: A meta-analysis of outcomes in brain AVMs by Spetzler-Martin grade

IF 1.9 4区医学 Q3 CLINICAL NEUROLOGY

Journal of Clinical Neuroscience Pub Date : 2025-04-02 DOI:10.1016/j.jocn.2025.111209

Cyrus Raki , Lily Davies , Leon T Lai

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Abstract

Preoperative embolisation is frequently used an adjunct to microsurgery for brain arteriovenous malformations (AVMs), yet high-level evidence supporting its routine use remains limited. This meta-analysis compares outcomes of microsurgery alone versus combined microsurgery and preoperative embolisation, stratified by Spetzler-Martin (SM) grade.

A systematic review of Embase, Medline, Scopus, Emcare, and the Cochrane Library identified 43 studies encompassing 3916 patients, equally divided between microsurgery alone (n = 1958) and combination therapy (n = 1958). Primary endpoints included functional dependence (modified Rankin Scale score > 2), angiographic obliteration, haemorrhagic complications, and intraoperative blood loss.

Pooled analyses demonstrated no significant differences in functional dependence (OR 0.65, 95 % CI 0.32–1.32, p = 0.21), obliteration rates (OR 1.15, 95 % CI 0.60–2.19, p = 0.63), haemorrhagic complications (OR 1.67, 95 % CI 0.71–3.95, p = 0.20), or intraoperative blood loss (MD −98.90 mL, 95 % CI −417.38–219.57, p = 0.44). Subgroup analysis for SM grade I-II and III-V AVMs found no significant differences in outcomes between treatment modalities. For SM grade III AVMs, angiographic cure rates were comparable, though data scarcity precluded a robust assessment of functional dependence, postoperative haemorrhage, and intraoperative blood loss.

While theoretical advantages exist for preoperative embolisation in higher-grade or high-flow AVMs, current evidence does not demonstrate consistent benefits in outcomes or complication rates. Further studies, particularly for SM grade III AVMs, are needed to determine whether combination therapy provides a meaningful advantage over microsurgery alone.

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单独显微手术与术前栓塞：根据Spetzler-Martin分级对脑动静脉畸形结局的meta分析

术前栓塞是显微手术治疗脑动静脉畸形（AVMs）的常用辅助手段，但支持其常规使用的高水平证据仍然有限。该荟萃分析比较了单独显微手术与联合显微手术和术前栓塞的结果，并按Spetzler-Martin （SM）分级进行分层。对Embase、Medline、Scopus、Emcare和Cochrane图书馆的系统综述确定了43项研究，包括3916例患者，平均分为单独显微手术（n = 1958）和联合治疗（n = 1958）。主要终点包括功能依赖(修正Rankin量表评分>；2)、血管造影闭塞、出血性并发症和术中失血。合并分析显示，功能依赖性（OR 0.65, 95% CI 0.32-1.32, p = 0.21）、闭塞率（OR 1.15, 95% CI 0.60-2.19, p = 0.63）、出血性并发症（OR 1.67, 95% CI 0.71-3.95, p = 0.20）、术中出血量（MD - 98.90 mL, 95% CI - 417.38-219.57, p = 0.44）无显著差异。SM I-II级和III-V级AVMs的亚组分析发现，治疗方式之间的结果无显著差异。对于SM III级avm，血管造影治愈率是相当的，尽管缺乏数据妨碍了对功能依赖、术后出血和术中失血的可靠评估。虽然理论上较高级别或高流量的动静脉畸形术前栓塞存在优势，但目前的证据并未证明在结果或并发症发生率方面有一致的益处。进一步的研究，特别是对于SM III级avm，需要确定联合治疗是否比单独显微手术有意义的优势。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Journal of Clinical Neuroscience 医学-临床神经学

CiteScore

4.50

自引率

0.00%

发文量

402

审稿时长

40 days

期刊介绍： This International journal, Journal of Clinical Neuroscience, publishes articles on clinical neurosurgery and neurology and the related neurosciences such as neuro-pathology, neuro-radiology, neuro-ophthalmology and neuro-physiology. The journal has a broad International perspective, and emphasises the advances occurring in Asia, the Pacific Rim region, Europe and North America. The Journal acts as a focus for publication of major clinical and laboratory research, as well as publishing solicited manuscripts on specific subjects from experts, case reports and other information of interest to clinicians working in the clinical neurosciences.