Related Experiment Video
Updated: Jun 5, 2025
Comprehensive Endovascular and Open Surgical Management of Cerebral Arteriovenous Malformations
Published on: October 20, 2017
A comparative analysis of microsurgical resection versus stereotactic radiosurgery for Spetzler-Martin grade III
Salem M Tos1, Bardia Hajikarimloo1, Mahmoud Osama1
1Department of Neurosurgery, University of Virginia, Charlottesville, VA, United States.
Background:
Spetzler-Martin (SM) Grade III brain arteriovenous malformations (BAVMs) represent a transitional risk zone between low- and high-grade BAVMs, characterized by diverse angioarchitecture. The primary treatment options are endovascular embolization, microsurgical resection (MS), and stereotactic radiosurgery (SRS). This study compares the efficacy and outcomes of MS and SRS.
Methods:
We conducted a multicenter, retrospective study involving patients from the MISTA database with SM Grade III BAVMs treated with MS or SRS between 2010 and 2023. Propensity matching was based on age, favorable modified Rankin Score (mRS) at presentation, nidus size, rupture status, location depth, and eloquence.
Results:
After matching, 60 patients were equally divided between MS and SRS groups. Median age (MS: 45.0 vs. SRS: 42.5 years, p = 0.3) and AVM size (MS: 3.2 vs. SRS: 2.9 cm3, p = 0.6) were similar. MS showed higher obliteration rates (93.3 %) compared to SRS (46.7 %) at the last follow-up (p < 0.001). The median time to obliteration post-SRS was 31.5 months (IQR: 15.3-60.0). SRS obliteration rates were 19 %, 29 %, and 59 % at 24, 36, and 60 months, respectively. Overall complication rates (MS: 30 % vs. SRS: 20 %, p = 0.4) and permanent complications (MS: 10 % vs. SRS: 13.3 %, p > 0.9) were similar. Hemorrhage occurred once in the MS group and none in the SRS (p > 0.9). Favorable outcomes (mRS 0-2) were higher with SRS than MS (93.3 % vs 80.0 %, p = 0.3), with one AVM-related mortality in the MS group.
Conclusion:
MS and SRS are viable treatments for SM Grade III BAVMs. Treatment choice should be individualized by a multidisciplinary team, considering patient goals.
Insights
Microsurgical resection (MS) offers higher obliteration rates for Spetzler-Martin Grade III brain arteriovenous malformations (BAVMs) than stereotactic radiosurgery (SRS). However, both MS and SRS are viable, with similar complication rates, necessitating individualized treatment plans.
Area of Science:
- Neurosurgery
- Interventional Neuroradiology
- Neurology
Background:
- Spetzler-Martin (SM) Grade III brain arteriovenous malformations (BAVMs) present a complex challenge due to their transitional risk and diverse angioarchitecture.
- Current treatment modalities for SM Grade III BAVMs include microsurgical resection (MS), stereotactic radiosurgery (SRS), and endovascular embolization.
- Comparing the efficacy and outcomes of MS and SRS is crucial for optimizing treatment strategies in this patient population.
Purpose of the Study:
- To compare the effectiveness and outcomes of microsurgical resection (MS) versus stereotactic radiosurgery (SRS) for treating Spetzler-Martin (SM) Grade III brain arteriovenous malformations (BAVMs).
- To evaluate obliteration rates, complication profiles, and functional outcomes between the two treatment modalities.
- To inform clinical decision-making for individualized treatment of SM Grade III BAVMs.
Main Methods:
- A multicenter, retrospective study utilizing the MISTA database.
- Inclusion of patients with SM Grade III BAVMs treated with MS or SRS between 2010 and 2023.
- Propensity score matching based on age, baseline modified Rankin Score (mRS), nidus size, rupture status, location depth, and eloquence to ensure comparable groups.
Main Results:
- After propensity matching, 60 patients (30 MS, 30 SRS) were analyzed; groups were similar in age and AVM size.
- Microsurgical resection (MS) demonstrated significantly higher obliteration rates (93.3%) compared to stereotactic radiosurgery (SRS) (46.7%) at last follow-up (p < 0.001).
- Overall and permanent complication rates were similar between MS (30% and 10%) and SRS (20% and 13.3%), respectively. Favorable outcomes (mRS 0-2) were higher with SRS (93.3%) than MS (80.0%).
Conclusions:
- Both microsurgical resection (MS) and stereotactic radiosurgery (SRS) are viable treatment options for Spetzler-Martin (SM) Grade III brain arteriovenous malformations (BAVMs).
- MS achieves higher obliteration rates, while SRS may be associated with better functional outcomes in some cases.
- Individualized treatment decisions, guided by a multidisciplinary team and patient-specific goals, are essential for optimal management of SM Grade III BAVMs.
