Evidence map›Paper›PMID 42168675›Full record

ArticleNeurosurgical review2026

International multi-center study to quantify the effect of deep venous drainage after surgical resection of Spetzler-Martin Grade II-III brain arteriovenous malformations.

Avi A Gajjar, Rashad Jabarkheel, Mohamed M Salem, Basel Musmar, Sandeep Kandregula, Hammam Abdalrazeq, Nimer Adeeb, Assala Aslan, Nathan Ramachandran, Stavropoula I Tjoumakaris and 66 more

Abstract readMulticenter Study
In one paragraph

Article in Neurosurgical review, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 1 paper.

0numbers the graph read from it
0cells of the map it votes in
1citing 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

1 citing paper in PubMed.

  1. Review
4 · The record

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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

76 authors.

Avi A Gajjar *Department of Neurosurgery, Hospital of the University of Pennsylvania (HUP), Penn Medicine, 3400 Civic Center Blvd, Philadelphia, PA, 19104, USA. avigajjar01@gmail.com.
Rashad Jabarkheel *Department of Neurosurgery, Hospital of the University of Pennsylvania (HUP), Penn Medicine, 3400 Civic Center Blvd, Philadelphia, PA, 19104, USA.
Mohamed M SalemDepartment of Neurosurgery, Hospital of the University of Pennsylvania (HUP), Penn Medicine, 3400 Civic Center Blvd, Philadelphia, PA, 19104, USA.
Basel MusmarDepartment of Neurosurgery, Thomas Jefferson University Hospital, Philadelphia, PA, USA.
Sandeep KandregulaDepartment of Neurosurgery, Hospital of the University of Pennsylvania (HUP), Penn Medicine, 3400 Civic Center Blvd, Philadelphia, PA, 19104, USA.
Hammam AbdalrazeqDepartment of Radiology, Louisiana State University, Shreveport, LA, USA.
Nimer AdeebDepartment of Neurosurgery, Louisiana State University Health Science Center, Shreveport, LA, USA.
Assala AslanDepartment of Radiology, Louisiana State University, Shreveport, LA, USA.
Nathan RamachandranDepartment of Neurosurgery, Albany Medical College, Albany, NY, USA.
Stavropoula I TjoumakarisDepartment of Neurosurgery, Thomas Jefferson University Hospital, Philadelphia, PA, USA.
Hamza Adel SalimDepartment of Radiology, Louisiana State University, Shreveport, LA, USA.
Adam A DmytriwNeuroendovascular Program, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA.
Christopher S OgilvyNeurosurgical Service, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA.
Mustafa K BaskayaDepartment of Neurosurgery, University of Wisconsin School of Medicine, Madison, WI, USA.
Douglas KondziolkaDepartment of Neurosurgery, New York University Grossman School of Medicine, New York, NY, USA.
Jason SheehanDepartment of Neurosurgery, University of Virginia, Charlottesville, VA, USA.
Howard RiinaDepartment of Neurosurgery, New York University Grossman School of Medicine, New York, NY, USA.
Abdallah AbushehabDepartment of Plastic Surgery, Mayo Clinic Hospital, Rochester, MN, USA.
Kareem El NaamaniDepartment of Neurosurgery, Thomas Jefferson University Hospital, Philadelphia, PA, USA.
Najib MuhammadDepartment of Neurosurgery, Hospital of the University of Pennsylvania (HUP), Penn Medicine, 3400 Civic Center Blvd, Philadelphia, PA, 19104, USA.
Ahmed AbdelsalamDepartment of Neurosurgery, University of Miami, Miller School of Medicine, Miami, FL, USA.
Natasha IronsideDepartment of Neurosurgery, University of Virginia, Charlottesville, VA, 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 AtaogluNeurosurgical Service, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA.
Muhammed Amir EssibayiMontefiore Einstein Cerebrovascular Research Lab, Department of Neurological Surgery, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY, USA.
Abdullah KelesNeurosurgical Service, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA.
Sandeep MuramNeuroendovascular Program, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA.
Daniel SconzoNeuroendovascular Program, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA.
Arwin RezaiDepartment of Neurosurgery, Christian Doppler Klinik, Paracelsus Medical University, Salzburg, Austria.
Omar AlwakaaNeuroendovascular Program, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA.
Pierce DavisDepartment of Neurosurgery, Hospital of the University of Pennsylvania (HUP), Penn Medicine, 3400 Civic Center Blvd, Philadelphia, PA, 19104, USA.
Salem M TosDepartment of Neurosurgery, University of Virginia, Charlottesville, VA, USA.
Ufuk ErginogluNeurosurgical Service, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA.
Johannes PöppeDepartment of Neurosurgery, Christian Doppler Klinik, Paracelsus Medical University, Salzburg, Austria.
Rajeev D SenDepartment of Neurosurgery, University of Washington, Seattle, WA, USA.
Alan S BoulosDepartment of Neurosurgery, Albany Medical College, Albany, NY, USA.
John C DalfinoDepartment of Neurosurgery, Albany Medical College, Albany, NY, USA.
Christoph J GriessenauerDepartment of Neurosurgery, Christian Doppler Klinik, Paracelsus Medical University, Salzburg, Austria.
Robert M StarkeDepartment of Neurosurgery, University of Miami, Miller School of Medicine, Miami, FL, 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, Bronx, NY, USA.
Neil HaranhalliMontefiore Einstein Cerebrovascular Research Lab, Department of Neurological Surgery, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY, USA.
Malia McAvoyDepartment of Neurosurgery, University of Washington, Seattle, WA, USA.
Hussein A ZeineddineDepartment of Neurosurgery, UT Health Sciences Center at Houston, McGovern Medical School, Houston, TX, USA.
Adib A AblaDepartment of Neurosurgery, University of Miami, Miller School of Medicine, Miami, FL, USA.
Saman SizdahkhaniDepartment of Neurosurgery, Thomas Jefferson University Hospital, Philadelphia, PA, USA.
Sravanthi KoduriDepartment of Neurosurgery, Thomas Jefferson University Hospital, Philadelphia, PA, USA.
M Reid GoochDepartment of Neurosurgery, Thomas Jefferson University Hospital, Philadelphia, PA, USA.
Robert H RosenwasserDepartment of Neurosurgery, Thomas Jefferson University Hospital, Philadelphia, PA, USA.
Christopher StapletonDepartment of Neurosurgery, Albany Medical College, Albany, NY, USA.
Matthew KochDepartment of Neurosurgery, University of Florida, Gainesville, FL, 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.
Ketan BulsaraDepartment of Neurosurgery, University of Connecticut, Farmington, CT, USA.
Louis J KimDepartment of Neurosurgery, University of Washington, Seattle, WA, USA.
Omar ChoudhriDepartment of Neurosurgery, Hospital of the University of Pennsylvania (HUP), Penn Medicine, 3400 Civic Center Blvd, Philadelphia, PA, 19104, USA.
Bryan PukenasDepartment of Neurosurgery, Hospital of the University of Pennsylvania (HUP), Penn Medicine, 3400 Civic Center Blvd, Philadelphia, PA, 19104, USA.
Joshua S CatapanoDepartment of Neurosurgery, Hospital of the University of Pennsylvania (HUP), Penn Medicine, 3400 Civic Center Blvd, Philadelphia, PA, 19104, USA.
Darren OrbachNeurointerventional Radiology, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA.
Edward SmithDepartment of Neurosurgery, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA.
Pascal J MosimannDivision of Interventional and Diagnostic Neuroradiology, Department of Radiology, University of Toronto & Toronto Western Hospital, Toronto, Canada.
Alexandra R PaulDepartment of Neurosurgery, Albany Medical College, Albany, NY, USA.
Pascal JabbourDepartment of Neurosurgery, Thomas Jefferson University Hospital, Philadelphia, PA, USA.
Ali AlarajDepartment of Neurosurgery, University of Illinois in Chicago, Chicago, IL, USA.
Mohammad A Aziz-SultanDepartment of Neurosurgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.
Aman B PatelDepartment of Neurosurgery, University of Virginia, Charlottesville, VA, USA.
Amey SavardekarDepartment of Neurosurgery, Louisiana State University Health Science Center, Shreveport, LA, USA.
Christina NotarianniDepartment 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.
Bharat GuthikondaDepartment of Neurosurgery, Louisiana State University Health Science Center, Shreveport, LA, USA.
Jacques MorcosDepartment of Neurosurgery, UT Health Sciences Center at Houston, McGovern Medical School, Houston, TX, USA.
Michael LawtonDepartment of Neurosurgery, Barrow Neurological Institute, Phoenix, AZ, USA.
Jan-Karl BurkhardtDepartment of Neurosurgery, Hospital of the University of Pennsylvania (HUP), Penn Medicine, 3400 Civic Center Blvd, Philadelphia, PA, 19104, USA. jan.burkhardt@pennmedicine.upenn.edu.
Visish M SrinivasanDepartment of Neurosurgery, Hospital of the University of Pennsylvania (HUP), Penn Medicine, 3400 Civic Center Blvd, Philadelphia, PA, 19104, USA. Visish.Srinivasan@Pennmedicine.upenn.edu.

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

Deep venous drainage (DVD) is considered a negative prognostic factor in AVM surgery, yet its effect on postoperative functional decline remains incompletely defined. This study evaluates whether DVD predicts worsened functional status after surgical resection of Spetzler-Martin Grade II-III AVMs. This retrospective multicenter study analyzed 129 patients with Spetzler-Martin Grade II-III AVMs across nine centers in North America and Europe who underwent primary surgical resection. We excluded cases with prior endovascular or stereotactic interventions. The primary outcome measured was poor functional status, defined as modified Rankin Scale (mRS) score 3-6 at last follow up. Among 129 patients with Spetzler-Martin Grade II-III AVMs, 38 (29.5%) exhibited deep venous drainage (DVD). Poor functional outcome (mRS ≥ 3) at last follow-up occurred in 14 patients (10.9%). This occurred in 6 of 38 patients with DVD (15.8%) compared with 8 of 91 without DVD (8.8%; Fisher's exact p = 0.244). On univariate Firth-penalized logistic regression, DVD was not significantly associated with poor outcome (OR 1.96, 95% CI 0.65-5.89; p = 0.228). In the primary reduced Firth model adjusting for age and pre-existing functional disability, DVD was independently associated with poor outcome (OR 6.87, 95% CI 1.07-44.20; p = 0.042). Increasing age (OR 1.08 per year, 95% CI 1.02-1.13; p = 0.004) and pre-existing functional disability (OR 6.53, 95% CI 1.63-26.22; p = 0.008) were also independently associated with poor outcome. DVD is associated with functional decline following surgical resection of Spetzler-Martin Grade II-III AVMs after adjustment for age and pre-existing functional disability.

Indexed as

Intracranial Arteriovenous MalformationsNeurosurgical ProceduresAdolescentAdultFemaleHumansMaleMiddle AgedPostoperative ComplicationsPrognosisRetrospective StudiesTreatment OutcomeYoung AdultArteriovenous malformationsAVMsDVDmRSSpetzler-Martin gradingSurgical outcomes

Identifiers

PMID42168675
PMCPMC13194320

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