{
  "abstract": "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.",
  "authors": [
    {
      "affiliations": [
        "Neurosurgery, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, USA"
      ],
      "name": "Basel Musmar"
    },
    {
      "affiliations": [
        "Neurosurgery, Louisiana State University Health Sciences Center Shreveport, Shreveport, Louisiana, USA"
      ],
      "name": "Nimer Adeeb"
    },
    {
      "affiliations": [
        "Neurosurgery, Louisiana State University Health Sciences Center Shreveport, Shreveport, Louisiana, USA"
      ],
      "name": "Hammam Abdalrazeq"
    },
    {
      "affiliations": [
        "Department of Radiology, Division of Neuroradiology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA"
      ],
      "name": "Hamza Adel Salim"
    },
    {
      "affiliations": [
        "Neurosurgery, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, USA"
      ],
      "name": "Joanna Roy"
    },
    {
      "affiliations": [
        "Neurosurgery, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, USA"
      ],
      "name": "Stavropoula I Tjoumakaris"
    },
    {
      "affiliations": [
        "Neurosurgery, University of Pennsylvania, Philadelphia, Pennsylvania, USA"
      ],
      "name": "Sandeep Kandregula"
    },
    {
      "affiliations": [
        "Neurosurgical Service, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA"
      ],
      "name": "Christopher S Ogilvy"
    },
    {
      "affiliations": [
        "Neurosurgery, New York University Medical Center, New York, New York, USA"
      ],
      "name": "Douglas Kondziolka"
    },
    {
      "affiliations": [
        "Neurosurgery, University of Virginia, Charlottesville, Virginia, USA"
      ],
      "name": "Jason P Sheehan"
    },
    {
      "affiliations": [
        "Neuroendovascular Program, Massachusetts General Hospital, Boston, Massachusetts, USA",
        "Neuroradiology, Oxford University Hospitals NHS Trust, Oxford, UK"
      ],
      "name": "Adam A Dmytriw"
    },
    {
      "affiliations": [
        "Radiology, Louisiana State University Health Sciences Center Shreveport, Shreveport, Louisiana, USA"
      ],
      "name": "Assala Aslan"
    },
    {
      "affiliations": [
        "Neurosurgery, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, USA"
      ],
      "name": "Pious Patel"
    },
    {
      "affiliations": [
        "Neurosurgery, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, USA"
      ],
      "name": "Matthews Lan"
    },
    {
      "affiliations": [
        "Neurosurgery, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, USA"
      ],
      "name": "Michael P Baldassari"
    },
    {
      "affiliations": [
        "Neurosurgery, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, USA"
      ],
      "name": "Sravanthi Koduri"
    },
    {
      "affiliations": [
        "Neurosurgery, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, USA"
      ],
      "name": "Elias Atallah"
    },
    {
      "affiliations": [
        "Neurosurgery, UTHealth Houston, Houston, Texas, USA"
      ],
      "name": "Hussein Zeineddine"
    },
    {
      "affiliations": [
        "Neurosurgery, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, USA"
      ],
      "name": "Mary-Katharine Pontarelli"
    },
    {
      "affiliations": [
        "Neurosurgery, UTHealth Houston, Houston, Texas, USA"
      ],
      "name": "Hussam Abou-Al-Shaar"
    },
    {
      "affiliations": [
        "Neurosurgery, Banner Health, Phoenix, Arizona, USA"
      ],
      "name": "Kareem El Naamani"
    },
    {
      "affiliations": [
        "Neurosurgery, University of Miami Health System, Miami, Florida, USA"
      ],
      "name": "Ahmed Abdelsalam"
    },
    {
      "affiliations": [
        "Neurosurgery, University of Virginia, Charlottesville, Virginia, USA"
      ],
      "name": "Natasha Ironside"
    },
    {
      "affiliations": [
        "Neurosurgery, Louisiana State University Health Sciences Center Shreveport, Shreveport, Louisiana, USA"
      ],
      "name": "Deepak Kumbhare"
    },
    {
      "affiliations": [
        "Neurosurgery, Louisiana State University Health Sciences Center Shreveport, Shreveport, Louisiana, USA"
      ],
      "name": "Sanjeev Gummadi"
    },
    {
      "affiliations": [
        "Neurosurgery, University of Wisconsin System, Madison, Wisconsin, USA"
      ],
      "name": "Mustafa Baskaya"
    },
    {
      "affiliations": [
        "Neurosurgery, University of Wisconsin System, Madison, Wisconsin, USA"
      ],
      "name": "Cagdas Ataoglu"
    },
    {
      "affiliations": [
        "Neurosurgery, University of Illinois Chicago, Chicago, Illinois, USA"
      ],
      "name": "Finn Mccarthy"
    },
    {
      "affiliations": [
        "Neurosurgery, University of Illinois Chicago, Chicago, Illinois, USA"
      ],
      "name": "Anthony Sanchez-Forteza"
    },
    {
      "affiliations": [
        "Neurosurgery, Montefiore Einstein Hospital, New York, New York, USA"
      ],
      "name": "Muhammed Amir Essibayi"
    },
    {
      "affiliations": [
        "Neurosurgery, University of Wisconsin System, Madison, Wisconsin, USA"
      ],
      "name": "Abdullah Keles"
    },
    {
      "affiliations": [
        "Neurosurgical Service, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA"
      ],
      "name": "Sandeep Muram"
    },
    {
      "affiliations": [
        "Neurosurgical Service, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA"
      ],
      "name": "Daniel Sconzo"
    },
    {
      "affiliations": [
        "Neurosurgery, New York University Grossman School of Medicine, New York, New York, USA"
      ],
      "name": "Howard Riina"
    },
    {
      "affiliations": [
        "Uniklinikum Salzburg - Christian-Doppler-Klinik, Salzburg, Salzburg, Austria"
      ],
      "name": "Arwin Rezai"
    },
    {
      "affiliations": [
        "Neurosurgical Service, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA"
      ],
      "name": "Omar Alwakaa"
    },
    {
      "affiliations": [
        "Neurosurgery, University of Virginia, Charlottesville, Virginia, USA"
      ],
      "name": "Salem M Tos"
    },
    {
      "affiliations": [
        "Neurosurgery, University of Virginia, Charlottesville, Virginia, USA"
      ],
      "name": "Georgios Mantziaris"
    },
    {
      "affiliations": [
        "Neurosurgery, University of Virginia, Charlottesville, Virginia, USA"
      ],
      "name": "Min S Park"
    },
    {
      "affiliations": [
        "Neurosurgery, Brigham and Women’s Hospital, Boston, Massachusetts, USA"
      ],
      "name": "Sahin Hanalioglu"
    },
    {
      "affiliations": [
        "Neurosurgery, University of Wisconsin System, Madison, Wisconsin, USA"
      ],
      "name": "Ufuk Erginoglu"
    },
    {
      "affiliations": [
        "Uniklinikum Salzburg - Christian-Doppler-Klinik, Salzburg, Salzburg, Austria"
      ],
      "name": "Johannes Pöppe"
    },
    {
      "affiliations": [
        "Neurological Surgery, University of Washington School of Medicine, Seattle, Washington, USA"
      ],
      "name": "Rajeev D Sen"
    },
    {
      "affiliations": [
        "University Hospital Salzburg - Christian Doppler Hospital, Salzburg, Salzburg, Austria"
      ],
      "name": "Christoph J Griessenauer"
    },
    {
      "affiliations": [
        "Pontificia Universidad Javeriana, Bogotá, Bogota, Colombia"
      ],
      "name": "Maria Isabel Ocampo-Navia"
    },
    {
      "affiliations": [
        "Neurosurgery, Hospital Universitario San Ignacio, Bogota, Colombia"
      ],
      "name": "Diego A Devia"
    },
    {
      "affiliations": [
        "Pontificia Universidad Javeriana, Bogotá, Bogota, Colombia"
      ],
      "name": "Wilfran Perez-Mendez"
    },
    {
      "affiliations": [
        "Neurosurgery, Hospital Universitario San Ignacio, Bogota, Colombia",
        "Radiology, Fundacion Cardioinfantil Instituto de Cardiologia, Bogota, Cundinamarca, Colombia"
      ],
      "name": "Juan C Puentes"
    },
    {
      "affiliations": [
        "Neurosurgery, Medical University of South Carolina, Charleston, South Carolina, USA"
      ],
      "name": "Rahim Abo Kasem"
    },
    {
      "affiliations": [
        "Neurosurgery, Medical University of South Carolina, Charleston, South Carolina, USA"
      ],
      "name": "Alejandro M Spiotta"
    },
    {
      "affiliations": [
        "Radiology, University of Massachusetts System, Boston, Massachusetts, USA"
      ],
      "name": "Ajit S Puri"
    },
    {
      "affiliations": [
        "Radiology, University of Massachusetts System, Boston, Massachusetts, USA"
      ],
      "name": "Jasmeet Singh"
    },
    {
      "affiliations": [
        "Radiology, University of Massachusetts Medical School, Worcester, Massachusetts, USA"
      ],
      "name": "Anna Luisa Kuhn"
    },
    {
      "affiliations": [
        "Department of Neurosurgery, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA"
      ],
      "name": "Jan Karl Burkhardt"
    },
    {
      "affiliations": [
        "Neurosurgery, University of Miami Health System, Miami, Florida, USA"
      ],
      "name": "Robert M Starke"
    },
    {
      "affiliations": [
        "Neurosurgery, University of Washington, Seattle, Washington, USA"
      ],
      "name": "Laligam N Sekhar"
    },
    {
      "affiliations": [
        "Neurological Surgery, University of Washington School of Medicine, Seattle, Washington, USA"
      ],
      "name": "Michael Levitt"
    },
    {
      "affiliations": [
        "Department of Neurosurgery, Montefiore Medical Center, Bronx, New York, USA"
      ],
      "name": "David Altschul"
    },
    {
      "affiliations": [
        "Neurosurgery, Montefiore Hospital and Medical Center, Bronx, New York, USA"
      ],
      "name": "Neil Haranhalli"
    },
    {
      "affiliations": [
        "Neurological Surgery, University of Washington, Seattle, Washington, USA"
      ],
      "name": "Malia McAvoy"
    },
    {
      "affiliations": [
        "Radiology, Louisiana State University Health Sciences Center Shreveport, Shreveport, Louisiana, USA"
      ],
      "name": "Marah Eltiti"
    },
    {
      "affiliations": [
        "Plastic Surgery, Mayo Clinic, Rochester, Minnesota, USA"
      ],
      "name": "Abdallah Abushehab"
    },
    {
      "affiliations": [
        "Orlando Health Corp, Orlando, Florida, USA"
      ],
      "name": "Paul Foreman"
    },
    {
      "affiliations": [
        "Department of Neurosurgery, The University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma, USA"
      ],
      "name": "Hakeem J Shakir"
    },
    {
      "affiliations": [
        "Neuroscience, St Vincent Mercy Hospital, Toledo, Ohio, USA"
      ],
      "name": "Osama O Zaidat"
    },
    {
      "affiliations": [
        "Neuroscience, St. Vincent Medical Center, Toledo, Ohio, USA"
      ],
      "name": "Mohammad AlMajali"
    },
    {
      "affiliations": [
        "Department of Neurosurgery, Boston Children’s Hospital, Boston, Massachusetts, USA"
      ],
      "name": "Marcella Ruppert-Gomez"
    },
    {
      "affiliations": [
        "Department of Neurosurgery, Boston Children’s Hospital, Boston, Massachusetts, USA"
      ],
      "name": "Alfred Pokmeng See"
    },
    {
      "affiliations": [
        "Neurological Surgery, University of Miami Health System, Miami, Florida, USA"
      ],
      "name": "Adib A Abla"
    },
    {
      "affiliations": [
        "Neurosurgery, Massachusetts General Hospital, Boston, Massachusetts, USA"
      ],
      "name": "Christopher J Stapleton"
    },
    {
      "affiliations": [
        "University of Florida, Gainesville, Florida, USA"
      ],
      "name": "Aashay Patel"
    },
    {
      "affiliations": [
        "University of Florida, Gainesville, Florida, USA"
      ],
      "name": "Andrew Nguyen"
    },
    {
      "affiliations": [
        "University of Florida, Gainesville, Florida, USA"
      ],
      "name": "Matthew J Koch"
    },
    {
      "affiliations": [
        "Department of Neurosurgery, University of Pennsylvania, Philadelphia, Pennsylvania, USA"
      ],
      "name": "Visish M Srinivasan"
    },
    {
      "affiliations": [
        "Neurosurgery, University of Texas John P and Katherine G McGovern Medical School Vivian L Smith Department of Neurosurgery, Houston, Texas, USA",
        "Neurosurgery, The University of Texas Health Science Center at Houston Vivian L Smith Department of Neurosurgery, Houston, Texas, USA"
      ],
      "name": "Peng Roc Chen"
    },
    {
      "affiliations": [
        "Neurosurgery, University of Texas Medical School at Houston Vivian L Smith Department of Neurosurgery, Houston, Texas, USA"
      ],
      "name": "Spiros Blackburn"
    },
    {
      "affiliations": [
        "Neurosurgery, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, USA"
      ],
      "name": "Rabab Alshahrani"
    },
    {
      "affiliations": [
        "Department of Neurosurgery, Thomas Jefferson University, Philadelphia, Pennsylvania, USA"
      ],
      "name": "M Reid Gooch"
    },
    {
      "affiliations": [
        "Neurosurgery, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, USA"
      ],
      "name": "Robert H Rosenwasser"
    },
    {
      "affiliations": [
        "Division of Neurosurgery, University of Connecticut, Farmington, Connecticut, USA"
      ],
      "name": "Ketan R Bulsara"
    },
    {
      "affiliations": [
        "Neurosurgery, The University of Texas Medical Branch at Galveston, Galveston, Texas, USA"
      ],
      "name": "Peter Kan"
    },
    {
      "affiliations": [
        "University of Washington, Seattle, Washington, USA"
      ],
      "name": "Louis J Kim"
    },
    {
      "affiliations": [
        "Neurosurgery, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA"
      ],
      "name": "Omar Choudhri"
    },
    {
      "affiliations": [
        "Radiology, University of Pennsylvania, Philadelphia, Pennsylvania, USA"
      ],
      "name": "Bryan Pukenas"
    },
    {
      "affiliations": [
        "Neuroradiology, Oxford University Hospitals NHS Foundation Trust, Oxford, UK"
      ],
      "name": "Davide Simonato"
    },
    {
      "affiliations": [
        "Radiology, Queen Mary Hospital, Hong Kong, Hong Kong"
      ],
      "name": "Yan-Lin Li"
    },
    {
      "affiliations": [
        "Neurosurgery, University of Illinois at Chicago, Chicago, Illinois, USA"
      ],
      "name": "Ali Alaraj"
    },
    {
      "affiliations": [
        "University of Oxford Nuffield Department of Clinical Neurosciences, Oxford, UK"
      ],
      "name": "Maurizio Fuschi"
    },
    {
      "affiliations": [
        "Massachusetts General Hospital, Boston, Massachusetts, USA"
      ],
      "name": "Aman B Patel"
    },
    {
      "affiliations": [
        "Neurosurgery, LSU Health Shreveport, Shreveport, Louisiana, USA"
      ],
      "name": "Amey Savardekar"
    },
    {
      "affiliations": [
        "Neurosurgery, Louisiana State University Health Sciences Center Shreveport, Shreveport, Louisiana, USA"
      ],
      "name": "Christina Notarianni"
    },
    {
      "affiliations": [
        "Department of Radiology and Interventional radiology, Ochsner-Louisiana State University, Shreveport, Louisiana, USA",
        "Department of Neurosurgery and Interventional Neuroradiology, Ochsner-Louisiana State University, Shreveport, Louisiana, USA"
      ],
      "name": "Hugo H Cuellar"
    },
    {
      "affiliations": [
        "Neurosurgery, Barrow Neurological Institute, Phoenix, Arizona, USA"
      ],
      "name": "Michael T Lawton"
    },
    {
      "affiliations": [
        "LSU Health Shreveport, Shreveport, Louisiana, USA"
      ],
      "name": "Bharat Guthikonda"
    },
    {
      "affiliations": [
        "Neurosurgery, UTHealth, Houston, Texas, USA"
      ],
      "name": "Jacques Morcos"
    },
    {
      "affiliations": [
        "Neurological surgery, Thomas Jefferson University, Philadelphia, Pennsylvania, USA"
      ],
      "name": "Pascal Jabbour"
    }
  ],
  "title": "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",
  "uid": "4fe552d2-8bc8-5f78-9a67-0172bfc33706"
}