Microsurgery Versus Stereotactic Radiosurgery for Brain Arteriovenous Malformations: A Matched Cohort Study

Area of Science:

• Neurosurgery
• Neurology
• Radiology

Background:

• Brain arteriovenous malformations (AVMs) are complex vascular lesions requiring definitive treatment.
• Microsurgery (MS) and stereotactic radiosurgery (SRS) are primary curative interventions for AVMs.
• Comparative efficacy of MS versus SRS for AVM treatment requires further elucidation.

Purpose of the Study:

• To compare the treatment outcomes of MS and SRS for brain AVMs.
• To evaluate the efficacy and safety of MS versus SRS in a matched cohort study.
• To determine the primary outcome of AVM obliteration without new permanent neurological deficit.

Main Methods:

• Retrospective, matched cohort study design.
• Evaluation of institutional databases for AVM patients treated with MS and SRS.
• 1:1 matching of MS-treated to SRS-treated patients based on AVM and patient characteristics.

Main Results:

• Matched cohorts of 59 patients each for MS and SRS.
• Similar rates of deficit-free AVM obliteration (69%) in both groups.
• Higher obliteration rate with MS (98%) versus SRS (72%), but increased permanent neurological deficit (31% vs 10%).
• Higher post-treatment hemorrhage rate in the SRS cohort (10% vs 0%).

Conclusions:

• MS and SRS provide comparable rates of deficit-free AVM obliteration.
• MS offers higher obliteration rates but with increased risk of neurological deficit.
• Treatment choice depends on balancing obliteration rates against neurological risk.