{
  "abstract": "Background Arteriovenous malformations (AVMs) are uncommon cerebral lesions that can cause significant neurological complications. Surgical resection is the gold standard for treatment, but endovascular embolization and stereotactic radiosurgery (SRS) are viable alternatives.Objective To compare the outcomes of endovascular embolization versus SRS in the treatment of AVMs with Spetzler-Martin grades I–III.Methods This study combined retrospective data from 10 academic institutions in North America and Europe. Patients aged 1 to 90 years who underwent endovascular embolization or SRS for AVMs with Spetzler-Martin grades I–III between January 2010 and December 2023 were included.Results The study included 244 patients, including 84 who had endovascular embolization and 160 who had SRS. Before propensity score matching (PSM), complete obliteration at the last follow-up was achieved in 74.5% of the SRS group compared with 57.8% of the embolization group (OR=0.47; 95% CI 0.26 to 0.48; P=0.01). After propensity score matching, SRS still achieved significantly higher occlusion rates at last follow-up (78.9% vs 55.3%; OR=0.32; 95% CI 0.12 to 0.90; P=0.03).Hemorrhagic complications were higher in the embolization group than in the SRS group, although this difference did not reach statistical significance after PSM (13.2% vs 2.6%; OR=5.6; 95% CI 0.62 to 50.47; P=0.12). Similarly, re-treatment rate was higher in the embolization group (10.5% vs 5.3%; OR=2.11; 95% CI 0.36 to 12.31; P=0.40) compared with the SRS group.Conclusion Our findings indicate that SRS has a significantly higher obliteration rate at last follow-up compared with endovascular embolization. Also, SRS has a higher tendency for fewer hemorrhagic complications and lower re-treatment rate. Further prospective studies are needed.",
  "authors": [
    {
      "affiliations": [
        "Department of Neurological Surgery, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, USA"
      ],
      "name": "Basel Musmar"
    },
    {
      "affiliations": [
        "Department of Neurosurgery, Louisiana State University Health Science Center, Shreveport, Louisiana, USA",
        "Department of Neurosurgery, UT Health Sciences Center at Houston, McGovern Medical School, Houston, Texas, USA"
      ],
      "name": "Nimer Adeeb"
    },
    {
      "affiliations": [
        "Department of Neurological Surgery, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, USA"
      ],
      "name": "Joanna M. Roy"
    },
    {
      "affiliations": [
        "Department of Neurological Surgery, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, USA"
      ],
      "name": "Hammam Abdalrazeq"
    },
    {
      "affiliations": [
        "Department of Neurological Surgery, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, USA"
      ],
      "name": "Stavropoula I Tjoumakaris"
    },
    {
      "affiliations": [
        "Department of Neurological Surgery, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, USA"
      ],
      "name": "Elias Atallah"
    },
    {
      "affiliations": [
        "Department of Radiology, Louisiana State University, Shreveport, Louisiana, USA"
      ],
      "name": "Hamza Adel Salim"
    },
    {
      "affiliations": [
        "Department of Neurosurgery, New York University Grossman School of Medicine, New York, New York, USA"
      ],
      "name": "Douglas Kondziolka"
    },
    {
      "affiliations": [
        "Department of Neurosurgery, University of Virginia, Charlottesville, Virginia, USA"
      ],
      "name": "Jason Sheehan"
    },
    {
      "affiliations": [
        "Department of Neurosurgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA"
      ],
      "name": "Christopher S Ogilvy"
    },
    {
      "affiliations": [
        "Department of Neurosurgery, New York University Grossman School of Medicine, New York, New York, USA"
      ],
      "name": "Howard Riina"
    },
    {
      "affiliations": [
        "Department of Neurosurgery, University of Pennsylvania, Philadelphia, Pennsylvania, USA"
      ],
      "name": "Sandeep Kandregula"
    },
    {
      "affiliations": [
        "Neuroendovascular Program, Massachusetts General Hospital, Boston, Massachusetts, USA"
      ],
      "name": "Adam A Dmytriw"
    },
    {
      "affiliations": [
        "Department of Neurological Surgery, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, USA"
      ],
      "name": "Kareem El Naamani"
    },
    {
      "affiliations": [
        "Department of Neurosurgery, University of Miami, Miller School of Medicine, Miami, FL, USA"
      ],
      "name": "Ahmed Abdelsalam"
    },
    {
      "affiliations": [
        "Department of Neurosurgery, University of Virginia, Charlottesville, Virginia, USA"
      ],
      "name": "Natasha Ironside"
    },
    {
      "affiliations": [
        "Department of Neurosurgery, Louisiana State University Health Science Center, Shreveport, Louisiana, USA"
      ],
      "name": "Deepak Kumbhare"
    },
    {
      "affiliations": [
        "Department of Neurosurgery, University of Wisconsin School of Medicine, Madison, WI, USA"
      ],
      "name": "Cagdas Ataoglu"
    },
    {
      "affiliations": [
        "Montefiore Einstein Cerebrovascular Research Lab and Department of Neurological Surgery, Montefiore Medical Center, Albert Einstein College of Medicine, New York, New York, USA"
      ],
      "name": "Muhammed Amir Essibayi"
    },
    {
      "affiliations": [
        "Department of Neurosurgery, University of Wisconsin School of Medicine, Madison, WI, USA"
      ],
      "name": "Abdullah Keles"
    },
    {
      "affiliations": [
        "Department of Neurosurgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA"
      ],
      "name": "Sandeep Muram"
    },
    {
      "affiliations": [
        "Department of Neurosurgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA"
      ],
      "name": "Daniel Sconzo"
    },
    {
      "affiliations": [
        "Department of Neurosurgery, Christian Doppler Klinik, Paracelsus Medical University, Salzburg, Austria"
      ],
      "name": "Arwin Rezai"
    },
    {
      "affiliations": [
        "Department of Neurosurgery, University of Wisconsin School of Medicine, Madison, WI, USA"
      ],
      "name": "Ufuk Erginoglu"
    },
    {
      "affiliations": [
        "Department of Neurosurgery, Christian Doppler Klinik, Paracelsus Medical University, Salzburg, Austria"
      ],
      "name": "Johannes Pöppe"
    },
    {
      "affiliations": [
        "Department of Neurosurgery, University of Washington, Seattle, WA, USA"
      ],
      "name": "Rajeev D Sen"
    },
    {
      "affiliations": [
        "Department of Neurosurgery, Christian Doppler Klinik, Paracelsus Medical University, Salzburg, Austria"
      ],
      "name": "Christoph J Griessenauer"
    },
    {
      "affiliations": [
        "Department of Neurosurgery, University of Pennsylvania, Philadelphia, Pennsylvania, USA"
      ],
      "name": "Jan-Karl Burkhardt"
    },
    {
      "affiliations": [
        "Department of Neurosurgery, University of Miami, Miller School of Medicine, Miami, FL, USA"
      ],
      "name": "Robert M Starke"
    },
    {
      "affiliations": [
        "Department of Neurosurgery, University of Wisconsin School of Medicine, Madison, WI, USA"
      ],
      "name": "Mustafa K Baskaya"
    },
    {
      "affiliations": [
        "Department of Neurosurgery, University of Washington, Seattle, WA, USA"
      ],
      "name": "Laligam N Sekhar"
    },
    {
      "affiliations": [
        "Department of Neurosurgery, University of Washington, Seattle, WA, USA"
      ],
      "name": "Michael R Levitt"
    },
    {
      "affiliations": [
        "Montefiore Einstein Cerebrovascular Research Lab and Department of Neurological Surgery, Montefiore Medical Center, Albert Einstein College of Medicine, New York, New York, USA"
      ],
      "name": "David J Altschul"
    },
    {
      "affiliations": [
        "Department of Neurosurgery, University of Washington, Seattle, WA, USA"
      ],
      "name": "Malia McAvoy"
    },
    {
      "affiliations": [
        "Department of Radiology, Louisiana State University, Shreveport, Louisiana, USA"
      ],
      "name": "Assala Aslan"
    },
    {
      "affiliations": [
        "Plastic Surgery, Mayo Clinic, Rochester, Minnesota, USA"
      ],
      "name": "Abdallah Abushehab"
    },
    {
      "affiliations": [
        "Department of Neurosurgery, Louisiana State University Health Science Center, Shreveport, Louisiana, USA"
      ],
      "name": "Christian Swaid"
    },
    {
      "affiliations": [
        "Department of Neurosurgery, University of Miami, Miller School of Medicine, Miami, FL, USA"
      ],
      "name": "Adib A Abla"
    },
    {
      "affiliations": [
        "Department of Neurological Surgery, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, USA"
      ],
      "name": "M. Reid Gooch"
    },
    {
      "affiliations": [
        "Department of Neurological Surgery, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, USA"
      ],
      "name": "Robert H Rosenwasser"
    },
    {
      "affiliations": [
        "Neuroendovascular Program, Massachusetts General Hospital, Boston, Massachusetts, USA"
      ],
      "name": "Christopher Stapleton"
    },
    {
      "affiliations": [
        "Department of Neurosurgery, University of Florida, Gainesville, FL, USA"
      ],
      "name": "Matthew Koch"
    },
    {
      "affiliations": [
        "Department of Neurosurgery, University of Pennsylvania, Philadelphia, Pennsylvania, USA"
      ],
      "name": "Visish M Srinivasan"
    },
    {
      "affiliations": [
        "Department of Neurosurgery, UT Health Sciences Center at Houston, McGovern Medical School, Houston, Texas, USA"
      ],
      "name": "Peng R Chen"
    },
    {
      "affiliations": [
        "Department of Neurosurgery, UT Health Sciences Center at Houston, McGovern Medical School, Houston, Texas, USA"
      ],
      "name": "Spiros Blackburn"
    },
    {
      "affiliations": [
        "Department of Neurosurgery, UT Health Sciences Center at Houston, McGovern Medical School, Houston, Texas, USA"
      ],
      "name": "Mark J Dannenbaum"
    },
    {
      "affiliations": [
        "Department of Neurosurgery, University of Pennsylvania, Philadelphia, Pennsylvania, USA"
      ],
      "name": "Omar Choudhri"
    },
    {
      "affiliations": [
        "Department of Neurosurgery, University of Pennsylvania, Philadelphia, Pennsylvania, USA"
      ],
      "name": "Bryan Pukenas"
    },
    {
      "affiliations": [
        "Neurointerventional Radiology, Boston Children’s Hospital, Harvard Medical School, Boston, MA, USA"
      ],
      "name": "Darren Orbach"
    },
    {
      "affiliations": [
        "Department of Neurosurgery, Boston Children’s Hospital, Harvard Medical School, Boston, MA, USA"
      ],
      "name": "Edward Smith"
    },
    {
      "affiliations": [
        "Division of Interventional and Diagnostic Neuroradiology, Department of Radiology, University of Toronto & Toronto Western Hospital, Toronto, Ontario, Canada"
      ],
      "name": "Pascal J Mosimann"
    },
    {
      "affiliations": [
        "Department of Neurosurgery, University of Illinois at Chicago, Chicago, Illinois, USA"
      ],
      "name": "Ali Alaraj"
    },
    {
      "affiliations": [
        "Department of Neurosurgery, Brigham and Women Hospital, Harvard Medical School, Boston, MA, USA"
      ],
      "name": "Mohammad A Aziz-Sultan"
    },
    {
      "affiliations": [
        "Neuroendovascular Program, Massachusetts General Hospital, Boston, Massachusetts, USA"
      ],
      "name": "Aman B Patel"
    },
    {
      "affiliations": [
        "Department of Neurosurgery, Louisiana State University Health Science Center, Shreveport, Louisiana, USA",
        "Department of Radiology, Louisiana State University, Shreveport, Louisiana, USA"
      ],
      "name": "Hugo H Cuellar"
    },
    {
      "affiliations": [
        "Department of Neurosurgery, Barrow Neurological Institute, Phoenix, Arizona, USA"
      ],
      "name": "Michael T Lawton"
    },
    {
      "affiliations": [
        "Department of Neurosurgery, UT Health Sciences Center at Houston, McGovern Medical School, Houston, Texas, USA"
      ],
      "name": "Jacques Morcos"
    },
    {
      "affiliations": [
        "Department of Neurosurgery, Louisiana State University Health Science Center, Shreveport, Louisiana, USA"
      ],
      "name": "Bharat Guthikonda"
    },
    {
      "affiliations": [
        "Department of Neurological Surgery, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, USA"
      ],
      "name": "Pascal Jabbour"
    }
  ],
  "title": "Comparing stand-alone endovascular embolization versus stereotactic radiosurgery in the treatment of arteriovenous malformations with Spetzler-Martin grades I–III: a propensity score matched study",
  "uid": "17cd1dd5-ddba-545f-b62d-93ee19f2b72d"
}