Treatment patterns and outcomes in elderly patients with brain arteriovenous malformations: a multicenter prospective...

This study aimed to evaluate long-term outcomes and hemorrhage risk in patients aged 60 years and older with brain arteriovenous malformations (AVMs) across different real-world management modalities.

We retrospectively analyzed 94 patients aged ≥ 60 years with AVMs from the MATCH study between August 2011 and December 2021. Patients were categorized into six treatment groups: conservative management, surgical resection, embolization, stereotactic radiosurgery (SRS), embolization plus resection, and combination therapy. Outcomes included annualized hemorrhage rate and functional status assessed by the modified Rankin Scale (mRS). Subgroup analyses were conducted based on sex, pretreatment hemorrhage, Spetzler-Martin grade, lesion location, flow-related aneurysm, and age.

Among the 94 patients (2.19% of 4286 total AVM cases), the median age was 64.95 years, and most had mild baseline disability (median mRS = 1). No statistically significant between-group differences were detected in perioperative complications or discharge mRS scores, although interpretation is limited by sparse-event distributions and limited statistical power. During follow-up, 9.57% of patients experienced hemorrhage, with higher rates observed in the embolization and SRS groups. Discharge mRS score and rupture history were associated with unfavorable functional outcomes, while embolization was associated with higher hemorrhage risk during follow-up.

In elderly AVM patients, functional outcomes should be interpreted in the context of baseline status and treatment selection. Resection-based approaches achieved the highest obliteration rates, whereas embolization and SRS were associated with higher observed follow-up hemorrhage risk. These findings support individualized management and close follow-up.

ClinicalTrials.gov, NCT04572568. Registered on September 7, 2020.