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