Safety and efficacy of preoperative embolization in the treatment of brain arteriovenous malformations with perinidal aneurysms and single draining vein: a multicenter study with propensity score-weighting.

IF 4.3 1区医学 Q1 NEUROIMAGING

Journal of NeuroInterventional Surgery Pub Date : 2025-08-22 DOI:10.1136/jnis-2025-023873

Basel Musmar, Nimer Adeeb, Hammam Abdalrazeq, Hamza Adel Salim, Joanna Roy, Stavropoula I Tjoumakaris, Sandeep Kandregula, Christopher S Ogilvy, Douglas Kondziolka, Jason P Sheehan, Adam A Dmytriw, Assala Aslan, Pious Patel, Matthews Lan, Michael P Baldassari, Sravanthi Koduri, Elias Atallah, Hussein Zeineddine, Mary-Katharine Pontarelli, Hussam Abou-Al-Shaar, Kareem El Naamani, Ahmed Abdelsalam, Natasha Ironside, Deepak Kumbhare, Sanjeev Gummadi, Mustafa Baskaya, Cagdas Ataoglu, Finn Mccarthy, Anthony Sanchez-Forteza, Muhammed Amir Essibayi, Abdullah Keles, Sandeep Muram, Daniel Sconzo, Howard Riina, Arwin Rezai, Omar Alwakaa, Salem M Tos, Georgios Mantziaris, Min S Park, Sahin Hanalioglu, Ufuk Erginoglu, Johannes Pöppe, Rajeev D Sen, Christoph J Griessenauer, Maria Isabel Ocampo-Navia, Diego A Devia, Wilfran Perez-Mendez, Juan C Puentes, Rahim Abo Kasem, Alejandro M Spiotta, Ajit S Puri, Jasmeet Singh, Anna Luisa Kuhn, Jan Karl Burkhardt, Robert M Starke, Laligam N Sekhar, Michael Levitt, David Altschul, Neil Haranhalli, Malia McAvoy, Marah Eltiti, Abdallah Abushehab, Paul Foreman, Hakeem J Shakir, Osama O Zaidat, Mohammad AlMajali, Marcella Ruppert-Gomez, Alfred Pokmeng See, Adib A Abla, Christopher J Stapleton, Aashay Patel, Andrew Nguyen, Matthew J Koch, Visish M Srinivasan, Peng Roc Chen, Spiros Blackburn, Rabab Alshahrani, M Reid Gooch, Robert H Rosenwasser, Ketan R Bulsara, Peter Kan, Louis J Kim, Omar Choudhri, Bryan Pukenas, Davide Simonato, Yan-Lin Li, Ali Alaraj, Maurizio Fuschi, Aman B Patel, Amey Savardekar, Christina Notarianni, Hugo H Cuellar, Michael T Lawton, Bharat Guthikonda, Jacques Morcos, Pascal Jabbour

{"title":"Safety and efficacy of preoperative embolization in the treatment of brain arteriovenous malformations with perinidal aneurysms and single draining vein: a multicenter study with propensity score-weighting.","authors":"Basel Musmar, Nimer Adeeb, Hammam Abdalrazeq, Hamza Adel Salim, Joanna Roy, Stavropoula I Tjoumakaris, Sandeep Kandregula, Christopher S Ogilvy, Douglas Kondziolka, Jason P Sheehan, Adam A Dmytriw, Assala Aslan, Pious Patel, Matthews Lan, Michael P Baldassari, Sravanthi Koduri, Elias Atallah, Hussein Zeineddine, Mary-Katharine Pontarelli, Hussam Abou-Al-Shaar, Kareem El Naamani, Ahmed Abdelsalam, Natasha Ironside, Deepak Kumbhare, Sanjeev Gummadi, Mustafa Baskaya, Cagdas Ataoglu, Finn Mccarthy, Anthony Sanchez-Forteza, Muhammed Amir Essibayi, Abdullah Keles, Sandeep Muram, Daniel Sconzo, Howard Riina, Arwin Rezai, Omar Alwakaa, Salem M Tos, Georgios Mantziaris, Min S Park, Sahin Hanalioglu, Ufuk Erginoglu, Johannes Pöppe, Rajeev D Sen, Christoph J Griessenauer, Maria Isabel Ocampo-Navia, Diego A Devia, Wilfran Perez-Mendez, Juan C Puentes, Rahim Abo Kasem, Alejandro M Spiotta, Ajit S Puri, Jasmeet Singh, Anna Luisa Kuhn, Jan Karl Burkhardt, Robert M Starke, Laligam N Sekhar, Michael Levitt, David Altschul, Neil Haranhalli, Malia McAvoy, Marah Eltiti, Abdallah Abushehab, Paul Foreman, Hakeem J Shakir, Osama O Zaidat, Mohammad AlMajali, Marcella Ruppert-Gomez, Alfred Pokmeng See, Adib A Abla, Christopher J Stapleton, Aashay Patel, Andrew Nguyen, Matthew J Koch, Visish M Srinivasan, Peng Roc Chen, Spiros Blackburn, Rabab Alshahrani, M Reid Gooch, Robert H Rosenwasser, Ketan R Bulsara, Peter Kan, Louis J Kim, Omar Choudhri, Bryan Pukenas, Davide Simonato, Yan-Lin Li, Ali Alaraj, Maurizio Fuschi, Aman B Patel, Amey Savardekar, Christina Notarianni, Hugo H Cuellar, Michael T Lawton, Bharat Guthikonda, Jacques Morcos, Pascal Jabbour","doi":"10.1136/jnis-2025-023873","DOIUrl":null,"url":null,"abstract":"Background and objectives: Arteriovenous malformations (AVMs) with perinidal aneurysms and single draining vein are associated with an elevated risk of rupture and increased procedural complexity. The role of preoperative embolization in this high-risk anatomical subset remains unclear. This study aimed to evaluate the safety and efficacy of microsurgery with preoperative embolization, compared with microsurgery alone in patients with such AVMs.Methods: We conducted a multicenter retrospective analysis of an AVM registry from the MISTA (Multicenter International Study for Treatment of Brain AVMs) consortium and included AVMs with perinidal aneurysms and a single draining vein. Baseline characteristics, angiographic outcomes, functional outcomes, and complication rates were compared. Propensity score weighting (PSW) using the covariate balancing method was applied to adjust for baseline differences.Results: Out of a total of 1919 patients, 65 met the inclusion criteria; 45 patients underwent preoperative embolization followed by microsurgery, and 20 underwent microsurgery alone. After adjustment, complete obliteration rates were similar between groups (OR 0.87, 95% CI 0.04 to 16.33, P=0.92), as were rates of functional independence at discharge and follow-up. Overall complication, symptomatic complication, and mortality rates did not differ significantly between groups. However, permanent complications were significantly lower in patients with preoperative embolization (OR 0.06, 95% CI 0.004 to 0.84, P=0.03).Discussion: In patients with AVMs featuring perinidal aneurysms and single draining vein, preoperative embolization followed by microsurgery was associated with fewer permanent complications and no increase in adverse outcomes compared with microsurgery alone. However, given the small number of events, this finding should be interpreted cautiously.","PeriodicalId":16411,"journal":{"name":"Journal of NeuroInterventional Surgery","volume":" ","pages":""},"PeriodicalIF":4.3000,"publicationDate":"2025-08-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Journal of NeuroInterventional Surgery","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1136/jnis-2025-023873","RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q1","JCRName":"NEUROIMAGING","Score":null,"Total":0}

引用次数: 0

Abstract

Background and objectives: Arteriovenous malformations (AVMs) with perinidal aneurysms and single draining vein are associated with an elevated risk of rupture and increased procedural complexity. The role of preoperative embolization in this high-risk anatomical subset remains unclear. This study aimed to evaluate the safety and efficacy of microsurgery with preoperative embolization, compared with microsurgery alone in patients with such AVMs.

Methods: We conducted a multicenter retrospective analysis of an AVM registry from the MISTA (Multicenter International Study for Treatment of Brain AVMs) consortium and included AVMs with perinidal aneurysms and a single draining vein. Baseline characteristics, angiographic outcomes, functional outcomes, and complication rates were compared. Propensity score weighting (PSW) using the covariate balancing method was applied to adjust for baseline differences.

Results: Out of a total of 1919 patients, 65 met the inclusion criteria; 45 patients underwent preoperative embolization followed by microsurgery, and 20 underwent microsurgery alone. After adjustment, complete obliteration rates were similar between groups (OR 0.87, 95% CI 0.04 to 16.33, P=0.92), as were rates of functional independence at discharge and follow-up. Overall complication, symptomatic complication, and mortality rates did not differ significantly between groups. However, permanent complications were significantly lower in patients with preoperative embolization (OR 0.06, 95% CI 0.004 to 0.84, P=0.03).

Discussion: In patients with AVMs featuring perinidal aneurysms and single draining vein, preoperative embolization followed by microsurgery was associated with fewer permanent complications and no increase in adverse outcomes compared with microsurgery alone. However, given the small number of events, this finding should be interpreted cautiously.

查看原文本刊更多论文

术前栓塞治疗脑动静脉畸形伴腹膜动脉瘤和单引流静脉的安全性和有效性：一项倾向评分加权的多中心研究。

背景和目的：动静脉畸形（AVMs）伴腹膜动脉瘤和单引流静脉，其破裂风险增加，手术复杂性增加。术前栓塞在这一高危解剖亚群中的作用尚不清楚。本研究旨在评价显微手术术前栓塞与单独显微手术治疗此类动静脉畸形的安全性和有效性。方法：我们对来自MISTA（多中心国际脑AVM治疗研究）联盟的AVM登记进行了多中心回顾性分析，并纳入了伴有周膜动脉瘤和单一引流静脉的AVM。比较基线特征、血管造影结果、功能结果和并发症发生率。采用协变量平衡法的倾向得分加权（PSW）来调整基线差异。结果：1919例患者中，65例符合纳入标准；术前栓塞后显微手术45例，单独显微手术20例。调整后，两组完全闭塞率相似（OR 0.87, 95% CI 0.04 ~ 16.33， P=0.92），出院和随访时功能独立性率相似。总并发症、症状并发症和死亡率在两组间无显著差异。然而，术前栓塞患者的永久性并发症明显降低（OR 0.06, 95% CI 0.004 ~ 0.84， P=0.03）。讨论：与单纯显微外科手术相比，术前栓塞后显微外科手术治疗伴有腹膜动脉瘤和单一引流静脉的动静脉畸形患者的永久性并发症更少，不良结局没有增加。然而，考虑到事件数量较少，这一发现应该谨慎解读。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

求助全文

约1分钟内获得全文求助全文

来源期刊

Journal of NeuroInterventional Surgery NEUROIMAGING-SURGERY

CiteScore

9.50

自引率

14.60%

发文量

291

审稿时长

4-8 weeks

期刊介绍： The Journal of NeuroInterventional Surgery (JNIS) is a leading peer review journal for scientific research and literature pertaining to the field of neurointerventional surgery. The journal launch follows growing professional interest in neurointerventional techniques for the treatment of a range of neurological and vascular problems including stroke, aneurysms, brain tumors, and spinal compression.The journal is owned by SNIS and is also the official journal of the Interventional Chapter of the Australian and New Zealand Society of Neuroradiology (ANZSNR), the Canadian Interventional Neuro Group, the Hong Kong Neurological Society (HKNS) and the Neuroradiological Society of Taiwan.