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Comprehensive Endovascular and Open Surgical Management of Cerebral Arteriovenous Malformations
Published on: October 20, 2017
Effects of Preoperative Embolization on Spetzler-Martin Grade I and II Arteriovenous Malformations: A
Joshua S Catapano1, Visish M Srinivasan, Kavelin Rumalla
1Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona, USA.
Background:
Cerebral arteriovenous malformations (AVMs) with low Spetzler-Martin grades (I and II) are associated with good neurological outcomes after microsurgical resection; however, the use of preoperative embolization for these lesions is controversial.
Objective:
To compare the neurological outcomes of preoperative embolization with no embolization in patients with low-grade AVMs.
Methods:
Patients with a Spetzler-Martin grade I or II AVM who underwent microsurgical resection during January 1, 1997, through December 31, 2019, were analyzed. Patients undergoing preoperative embolization were compared with patients not undergoing embolization. A propensity score was constructed from baseline characteristics and used to match intervention (embolization) and control (nonembolization) groups in a 1:1 ratio. The primary outcome was poor neurological status on last follow-up examination, defined as a modified Rankin Scale score >2 and a modified Rankin Scale score worse at follow-up than at the preoperative examination.
Results:
Of the 603 patients analyzed, 310 (51.4%) underwent preoperative embolization and 293 (48.6%) did not. Patients in the embolization cohort compared with those in the nonembolization cohort had a higher percentage of Spetzler-Martin grade II AVMs (71.6% vs 52.6%, P < .001) and a lower percentage of hemorrhage (41% vs 55%, P = .001). After propensity score matching, no differences were found between paired cohorts (each N = 203) for baseline characteristics with a significant reduction in absolute standardized mean differences. No significant differences were found in primary outcomes between treatment groups in the matched or unmatched cohorts.
Conclusion:
Preoperative embolization of low-grade Spetzler-Martin AVMs is not associated with improved neurological outcomes after microsurgical resection.
Insights
Preoperative embolization for low-grade cerebral arteriovenous malformations (AVMs) does not improve neurological outcomes after surgery. This study found no significant differences in outcomes between embolized and non-embolized patients with Spetzler-Martin grades I and II AVMs.
Area of Science:
- Neurosurgery
- Vascular Neurology
- Interventional Neuroradiology
Background:
- Low-grade cerebral arteriovenous malformations (AVMs), Spetzler-Martin grades I and II, typically have good outcomes after microsurgical resection.
- The role of preoperative embolization for these low-grade AVMs remains a subject of debate.
Purpose of the Study:
- To compare neurological outcomes in patients with low-grade AVMs who received preoperative embolization versus those who did not.
- To evaluate the efficacy of preoperative embolization in conjunction with microsurgical resection for Spetzler-Martin grade I and II AVMs.
Main Methods:
- A retrospective analysis of 603 patients with Spetzler-Martin grade I or II AVMs who underwent microsurgical resection between 1997 and 2019.
- Propensity score matching was used to create comparable cohorts of patients who underwent preoperative embolization and those who did not.
- The primary outcome was poor neurological status at follow-up, defined by modified Rankin Scale scores.
Main Results:
- After propensity score matching (N=203 per group), no significant differences in neurological outcomes were observed between the embolization and non-embolization groups.
- The embolization cohort had a higher proportion of Spetzler-Martin grade II AVMs and a lower incidence of hemorrhage compared to the non-embolization cohort prior to matching.
- No significant differences in primary outcomes were found in either the matched or unmatched cohorts.
Conclusions:
- Preoperative embolization is not associated with improved neurological outcomes for low-grade cerebral AVMs (Spetzler-Martin grades I and II) undergoing microsurgical resection.
- The findings suggest that routine preoperative embolization may not be beneficial for this patient population.
- Further research may explore specific AVM subtypes or patient factors that could potentially benefit from embolization.
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