Efficacy and Safety of Preoperative Embolization in Surgical Treatment of Brain Arteriovenous Malformations: A Propensity Score-Matched Study

Background: Surgical resection of cerebral arteriovenous malformations (AVMs) can be associated with significant risks, including hemorrhage due to intraoperative or postoperative rupture, which can lead to severe morbidity and mortality. Preoperative embolization is often employed to enhance the safety and efficacy of surgical resection of AVMs. However, the benefits and risks of this approach remain contentious. Prior studies were limited by the small number of cases and lack of matched analysis. This multicenter international study aims to evaluate the efficacy and safety of preoperative embolization in the surgical treatment of brain AVMs on a larger scale.

Methods: The Multicenter International Study for Treatment of Brain AVMs (MISTA) consortium combined retrospective data from multiple academic institutions in North America and Europe. The study included patients with both ruptured and unruptured AVMs who underwent surgical resection with or without preoperative endovascular embolization. Data were collected using standardized datasheets that captured patient demographics, AVM characteristics, procedural details, complications, and both angiographic and functional outcomes. Institutional review board (IRB) approval was obtained at each site. Propensity score matching (PSM) was employed to balance the cohorts for comparison, controlling for potential confounders.

Results: The study included 486 patients, with 245 undergoing surgery only and 241 receiving preoperative embolization. After PSM, 288 patients were included (144 in each group). The matched cohorts showed no significant differences in baseline characteristics such as age, gender, race, and comorbidities. The median nidus size was 2.20 cm, with significant differences between groups before matching, but not after. The Spetzler–Martin grade distribution was balanced post-matching. Complete obliteration at last follow-up was achieved in 97% of patients, with no significant difference between groups. The proportion of patients with a modified Rankin’s scale (mRS) score of 0 to 2 at last clinical follow-up was similar between the surgery-only group (83%) and the preoperative embolization group (84%). However, the median length of hospital stay was significantly shorter in the surgery-only group (7 days) compared to the preoperative embolization group (9 days). Complications, including post-surgical rupture, recurrence, retreatment, and mortality rates, did not show significant differences between the groups.

Conclusion: This study provides important insights into the efficacy and safety of preoperative embolization in the surgical treatment of brain AVMs. Although preoperative embolization did not significantly enhance surgical outcomes, it did not adversely affect complication rates. Further research is warranted to refine patient selection criteria and optimize treatment protocols to ensure the best possible outcomes for patients with brain AVMs.

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Artikel online veröffentlicht:
07. Februar 2025