Evidence map›Paper›PMID 40159532›Full record

ArticleNeurosurgical review2025

Spetzler-martin grade IV cerebral arteriovenous malformations in adult patients: a propensity-score matched analysis of resection and stereotactic radiosurgery.

Salem M Tos, Mahmoud Osama, Georgios Mantziaris, Bardia Hajikarimloo, Nimer Adeeb, Sandeep Kandregula, Hamza Adel Salim, Basel Musmar, Christopher S Ogilvy, Douglas Kondziolka and 54 more

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Article in Neurosurgical review, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 3 papers.

0numbers the graph read from it
0cells of the map it votes in
3citing papers in PubMed
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

3 citing papers in PubMed.

  1. Review
  2. Article
  3. Review
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

64 authors.

Salem M TosDepartment of Neurosurgery, University of Virginia, Charlottesville, VA, USA.
Mahmoud OsamaDepartment of Neurosurgery, University of Virginia, Charlottesville, VA, USA.
Georgios MantziarisDepartment of Neurosurgery, University of Virginia, Charlottesville, VA, USA.
Bardia HajikarimlooDepartment of Neurosurgery, University of Virginia, Charlottesville, VA, USA.
Nimer AdeebDepartment of Neurosurgery, Louisiana State University Health Science Center, Shreveport, LA, USA.
Sandeep KandregulaDepartment of Neurosurgery, University of Pennsylvania, Philadelphia, PA, USA.
Hamza Adel SalimDepartment of Radiology, Louisiana State University, Shreveport, LA, USA.
Basel MusmarDepartment of Neurosurgery, Thomas Jefferson University Hospital, Philadelphia, PA, USA.
Christopher S OgilvyDivision of Neurosurgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA.
Douglas KondziolkaDepartment of Neurosurgery, New York University Grossman School of Medicine, Manhattan, NY, USA.
Adam A DmytriwNeuroendovascular Program, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA.
Kareem El NaamaniDepartment of Neurosurgery, Thomas Jefferson University Hospital, Philadelphia, PA, USA.
Ahmed AbdelsalamDepartment of Neurosurgery, University of Miami, Miller School of Medicine, Miami, FL, USA.
Deepak KumbhareDepartment of Neurosurgery, Louisiana State University Health Science Center, Shreveport, LA, USA.
Sanjeev GummadiDepartment of Neurosurgery, Louisiana State University Health Science Center, Shreveport, LA, USA.
Cagdas AtaogluDepartment of Neurosurgery, University of Wisconsin School of Medicine, Madison, WI, USA.
Muhammed Amir EssibayiMontefiore Einstein Cerebrovascular Research Lab, Department of Neurological Surgery, Montefiore Medical Center, Albert Einstein College of Medicine, NY, USA.
Ufuk ErginogluDepartment of Neurosurgery, University of Wisconsin School of Medicine, Madison, WI, USA.
Abdullah KelesDepartment of Neurosurgery, University of Wisconsin School of Medicine, Madison, WI, USA.
Sandeep MuramDivision of Neurosurgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA.
Daniel SconzoDivision of Neurosurgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA.
Howard RiinaDepartment of Neurosurgery, New York University Grossman School of Medicine, Manhattan, NY, USA.
Arwin RezaiDepartment of Neurosurgery, Christian Doppler Klinik, Paracelsus Medical University, Salzburg, Austria.
Johannes PöppeDepartment of Neurosurgery, Christian Doppler Klinik, Paracelsus Medical University, Salzburg, Austria.
Rajeev D SenDepartment of Neurosurgery, University of Washington, Seattle, WA, USA.
Louis J KimDepartment of Neurosurgery, University of Washington, Seattle, WA, USA.
Omar AlwakaaDivision of Neurosurgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA.
Christoph J GriessenauerDepartment of Neurosurgery, Christian Doppler Klinik, Paracelsus Medical University, Salzburg, Austria.
Pascal JabbourDepartment of Neurosurgery, Thomas Jefferson University Hospital, Philadelphia, PA, USA.
Stavropoula I TjoumakarisDepartment of Neurosurgery, Thomas Jefferson University Hospital, Philadelphia, PA, USA.
Jan-Karl BurkhardtDepartment of Neurosurgery, University of Pennsylvania, Philadelphia, PA, USA.
Robert M StarkeDepartment of Neurosurgery, University of Miami, Miller School of Medicine, Miami, FL, USA.
Mustafa K BaskayaDepartment of Neurosurgery, University of Wisconsin School of Medicine, Madison, WI, USA.
Laligam N SekharDepartment of Neurosurgery, University of Washington, Seattle, WA, USA.
Michael R LevittDepartment of Neurosurgery, University of Washington, Seattle, WA, USA.
David J AltschulMontefiore Einstein Cerebrovascular Research Lab, Department of Neurological Surgery, Montefiore Medical Center, Albert Einstein College of Medicine, NY, USA.
Neil HaranhalliMontefiore Einstein Cerebrovascular Research Lab, Department of Neurological Surgery, Montefiore Medical Center, Albert Einstein College of Medicine, NY, USA.
Malia McAvoyDepartment of Plastic Surgery, Mayo Clinic Hospital, Rochester, MN, USA.
Abdallah AbushehabDepartment of Neurosurgery, University of Florida, Gainesville, FL, USA.
Assala AslanDepartment of Radiology, Louisiana State University, Shreveport, LA, USA.
Christian SwaidDepartment of Neurosurgery, Louisiana State University Health Science Center, Shreveport, LA, USA.
Adib AblaDepartment of Neurosurgery, University of Miami, Miller School of Medicine, Miami, FL, USA.
Christopher StapletonNeuroendovascular Program, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA.
Matthew KochNeurointerventional Radiology, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA.
Visish M SrinivasanDepartment of Neurosurgery, University of Pennsylvania, Philadelphia, PA, USA.
Peng R ChenDepartment of Neurosurgery, UT Health Sciences Center at Houston, McGovern Medical School, Houston, TX, USA.
Spiros BlackburnDepartment of Neurosurgery, UT Health Sciences Center at Houston, McGovern Medical School, Houston, TX, USA.
Omar ChoudhriDepartment of Neurosurgery, University of Pennsylvania, Philadelphia, PA, USA.
Bryan PukenasDepartment of Neurosurgery, University of Pennsylvania, Philadelphia, PA, USA.
Darren OrbachNeuroendovascular Program, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA.
Edward SmithDepartment of Neurosurgery, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA.
Markus MöhlenbruchInterventional Neuroradiology, Department of Neuroradiology, Heidelberg University Hospital, Heidelberg, Germany.
Ali AlarajDepartment of Neurosurgery, University of Illinois in Chicago, Chicago, IL, USA.
Ali Aziz-SultanDepartment of Neurosurgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.
Aman B PatelNeuroendovascular Program, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA.
Amey SavardekarDepartment of Neurosurgery, Louisiana State University Health Science Center, Shreveport, LA, USA.
Hugo H CuellarDepartment of Neurosurgery, Louisiana State University Health Science Center, Shreveport, LA, USA.
Kathleen DlouhyDepartment of Neurosurgery, University of Iowa, Iowa City, IA, USA.
Tarek El AhmadiehDepartment of Neurosurgery, Loma Linda University, Redlands, CA, USA.
Michael LawtonDepartment of Neurosurgery, Barrow Neurological Institute, Phoenix, AZ, USA.
Adnan SiddiquiDepartment of Neurosurgery, State University of New York at Buffalo, Buffalo, NY, USA.
Jacques MorcosDepartment of Neurosurgery, UT Health Sciences Center at Houston, McGovern Medical School, Houston, TX, USA.
Bharat GuthikondaDepartment of Neurosurgery, Louisiana State University Health Science Center, Shreveport, LA, USA.
Jason SheehanDepartment of Neurosurgery, University of Virginia, Charlottesville, VA, USA. jps2f@virginia.edu.

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

Spetzler-Martin Grade IV arteriovenous malformations (AVMs) are challenging due to high risks associated with both treatment and natural progression. This study compares the outcomes of microsurgical resection and stereotactic radiosurgery (SRS) in high-grade AVMs, analyzing obliteration rates, complications, and functional outcomes. A retrospective cohort of 96 patients treated with either microsurgical resection (33 patients) or SRS (63 patients) was analyzed. Propensity-score matching was employed to account for baseline variables such as AVM size (cm), preoperative embolization and rupture status. Primary endpoints included AVM obliteration, complication rates, and modified Rankin Scale (mRS) scores. After matching, 31 patients per group were analyzed. Microsurgical resection achieved significantly higher obliteration rates (87.1%) compared to SRS (32.3%, p < 0.001). In the matched SRS cohort (n = 31), the actuarial obliteration rates were 11% (95% CI: 0-22%) at 1 year, 17% (95% CI: 0-31%) at 3 years, and 43% (95% CI: 13-63%) at 5 years post-treatment. Complication rates were similar (32.3% resection, 38.7% SRS, p = 0.6). Functional outcomes in terms of improvement in modified Rankin Scale (mRS) scores were observed in 50.0% of microsurgery patients and 41.4% of SRS patients. However, the absolute number of patients improving was similar (13 vs. 12), and the microsurgery group had more cases of worsening mRS scores compared to the SRS group (4 vs. 2). The difference was not statistically significant (p = 0.4). Microsurgical resection offers superior obliteration rates for high-grade AVMs with comparable complication risks to SRS. SRS remains a valuable alternative for select patients, particularly those ineligible for resection. Future research should focus on optimizing multimodal treatment approaches. Clinical trial number Not applicable.

Indexed as

Intracranial Arteriovenous MalformationsMicrosurgeryNeurosurgical ProceduresRadiosurgeryAdultAgedFemaleHumansMaleMiddle AgedPropensity ScoreRetrospective StudiesTreatment OutcomeYoung AdultAVM obliterationCerebral arteriovenous malformationsComplication rates and functional outcomesResectionSpetzler-martin grade IVStereotactic radiosurgery

Identifiers

PMID40159532
PMCPMC11955433

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