Citations 1
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
Adeeb, Nimer , Abdalrazeq, Hammam , Salim, Hamza , Tjoumakaris, Stavropoula , Kandregula, Sandeep , Ogilvy, Christopher S. , Sheehan, Jason , Aslan, Assala , Patel, Pious D. , Lan, Matthews , Baldassari, Michael P. , Koduri, Sravanthi , Atallah, Elias , Zeineddine, Hussein A. , Pontarelli, Mary-Katharine , Naamani, Kareem El, Ironside, Natasha , Gummadi, Sanjeev, Başkaya, Mustafa K. , Ataoglu, Cagdas , Mccarthy, Finn, Sanchez‐Forteza, Anthony , Essibayi, Muhammed Amir , Muram, Sandeep , Sconzo, Daniel , Riina, Howard A. , Rezai, Arwin, Alwakaa, Omar , Erginoğlu, Ufuk , Sen, Rajeev , Devia, Diego A., Perez-Mendez, Wilfran, Puentes, Juan C. , Spiotta, Alejandro M , Puri, Ajit S , Singh, Jasmeet, Burkhardt, Jan Karl, Starke, Robert M., Sekhar, Laligam N., Haranhalli, Neil , McAvoy, Malia , Eltiti, Marah, Abushehab, Abdallah, Foreman, Paul M. , Zaidat, Osama O. , Ruppert-Gomez, Marcella , Stapleton, Christopher J. , Koch, Matthew J. , Srinivasan, Visish M, Alshahrani, Rabab, Gooch, M Reid, Rosenwasser, Robert H. , Bulsara, Ketan R., Kan, Peter , Kim, Louis J. , Pukenas, Bryan , Li, Yan-Lin , Alaraj, Ali , Fuschi, Maurizio , Patel, Aman B. , Notarianni, Christina , Cuellar, Hugo H, Lawton, Michael T., Guthikonda, Bharat , Jabbour, Pascal , Salim, Hamza , Tjoumakaris, Stavropoula , Kandregula, Sandeep , Ogilvy, Christopher S , Dmytriw, Adam A , Aslan, Assala , Essibayi, Muhammed Amir , Alwakaa, Omar , Griessenauer, Christoph J , Abo Kasem, Rahim , Spiotta, Alejandro M , Levitt, Michael R , Altschul, David J , Shakir, Hakeem J , Zaidat, Osama O , Stapleton, Christopher , Koch, Matthew J , Chen, Peng R , Kan, Peter , Choudhri, Omar , Alaraj, Ali , Guthikonda, Bharat , Jabbour, Pascal , Erginoglu, Ufuk , Li, Yan-Lin , Burkhardt, Jan‐Karl , Musmar, Basel , Roy, Joanna M. , Kondziolka, Douglas , Dmytriw, Adam A. , Abou‐Al‐Shaar, Hussam , Naamani, Kareem El, Abdelsalam, Ahmed , Kumbhare, Deepak , Mccarthy, Finn, Keleş, Abdullah , Tos, Salem M , Mantziaris, Georgios , Park, Min S, Hanalıoğlu, Şahin , Pöppe, Johannes , Sen, Rajeev D, Griessenauer, Christoph J. , Ocampo-Navia, María Isabel , Kasem, Rahim Abo , Kühn, Anna Luisa , Sekhar, Laligam N. , Levitt, Michael R. , Altschul, David , Almajali, Mohammad , See, Alfred P. , Abla, Adib A. , Patel, Aashay , Nguyen, Andrew , Srinivasan, Visish M. , Blackburn, Spiros , Gooch, Michael Reid , Kim, Louis J. , Choudhri, Omar , Simonato, Davide , Savardekar, Amey Rajan , Lawton, Michael T. , Morcos, Jacques J.
Journal of NeuroInterventional Surgery | August 22, 2025 | Volume: 18 | Issue: 8 | Pages: 1765-1772
Background and objectives Arteriovenous malformations (AVMs) with perinidal aneurysms and single draining vein are associated with an elevated risk of rupture and increased procedural complexity. The role of preoperative embolization in this high-risk anatomical subset remains unclear. This study aimed to evaluate the safety and efficacy of microsurgery with preoperative embolization, compared with microsurgery alone in patients with such AVMs. 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.