Microsurgery Versus Stereotactic Radiosurgery for Brain Arteriovenous Malformations: A Matched Cohort Study

Ching Jen Chen, Dale Ding, Tony R. Wang, Thomas J. Buell, Adeel Ilyas, Natasha Ironside, Cheng Chia Lee, M. Yashar Kalani, Min S. Park, Kenneth C. Liu, Jason P. Sheehan

Research output: Contribution to journalArticle

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Abstract

BACKGROUND: Microsurgery (MS) and stereotactic radiosurgery (SRS) remain the preferred interventions for the curative treatment of brain arteriovenous malformations (AVM), but their relative efficacy remains incompletely defined. OBJECTIVE: To compare the outcomes of MS to SRS for AVMs through a retrospective, matched cohort study. METHODS: We evaluated institutional databases of AVM patients who underwent MS and SRS. MS-treated patients were matched, in a 1:1 ratio based on patient and AVM characteristics, to SRS-treated patients. Statistical analyses were performed to compare outcomes data between the 2 cohorts. The primary outcome was defined as AVM obliteration without a new permanent neurological deficit. RESULTS: The matched MS and SRS cohorts were each comprised of 59 patients. Both radiological (85 vs 11 mo; P < .001) and clinical (92 vs 12 mo; P < .001) follow-up were significantly longer for the SRS cohort. The primary outcome was achieved in 69% of each cohort. The MS cohort had a significantly higher obliteration rate (98% vs 72%; P = .001), but also had a significantly higher rate of new permanent deficit (31% vs 10%; P= .011). The post-treatment hemorrhage rate was significantly higher for the SRS cohort (10% for SRS vs 0%forMS; P=.027). In subgroup analyses of ruptured and unruptured AVMs, no significant differences between the primary outcomes were observed. CONCLUSION: For patients with comparable AVMs, MS and SRS afford similar rates of deficit-free obliteration. Nidal obliteration is more frequently achieved with MS, but this intervention also incurs a greater risk of new permanent neurological deficit.

Original languageEnglish (US)
Pages (from-to)696-707
Number of pages12
JournalClinical Neurosurgery
Volume84
Issue number3
DOIs
StatePublished - Mar 1 2019

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Microsurgery
Radiosurgery
Arteriovenous Malformations
Cohort Studies
Brain
Databases
Hemorrhage

All Science Journal Classification (ASJC) codes

  • Surgery
  • Clinical Neurology

Cite this

Chen, C. J., Ding, D., Wang, T. R., Buell, T. J., Ilyas, A., Ironside, N., ... Sheehan, J. P. (2019). Microsurgery Versus Stereotactic Radiosurgery for Brain Arteriovenous Malformations: A Matched Cohort Study. Clinical Neurosurgery, 84(3), 696-707. https://doi.org/10.1093/neuros/nyy174
Chen, Ching Jen ; Ding, Dale ; Wang, Tony R. ; Buell, Thomas J. ; Ilyas, Adeel ; Ironside, Natasha ; Lee, Cheng Chia ; Kalani, M. Yashar ; Park, Min S. ; Liu, Kenneth C. ; Sheehan, Jason P. / Microsurgery Versus Stereotactic Radiosurgery for Brain Arteriovenous Malformations : A Matched Cohort Study. In: Clinical Neurosurgery. 2019 ; Vol. 84, No. 3. pp. 696-707.
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title = "Microsurgery Versus Stereotactic Radiosurgery for Brain Arteriovenous Malformations: A Matched Cohort Study",
abstract = "BACKGROUND: Microsurgery (MS) and stereotactic radiosurgery (SRS) remain the preferred interventions for the curative treatment of brain arteriovenous malformations (AVM), but their relative efficacy remains incompletely defined. OBJECTIVE: To compare the outcomes of MS to SRS for AVMs through a retrospective, matched cohort study. METHODS: We evaluated institutional databases of AVM patients who underwent MS and SRS. MS-treated patients were matched, in a 1:1 ratio based on patient and AVM characteristics, to SRS-treated patients. Statistical analyses were performed to compare outcomes data between the 2 cohorts. The primary outcome was defined as AVM obliteration without a new permanent neurological deficit. RESULTS: The matched MS and SRS cohorts were each comprised of 59 patients. Both radiological (85 vs 11 mo; P < .001) and clinical (92 vs 12 mo; P < .001) follow-up were significantly longer for the SRS cohort. The primary outcome was achieved in 69{\%} of each cohort. The MS cohort had a significantly higher obliteration rate (98{\%} vs 72{\%}; P = .001), but also had a significantly higher rate of new permanent deficit (31{\%} vs 10{\%}; P= .011). The post-treatment hemorrhage rate was significantly higher for the SRS cohort (10{\%} for SRS vs 0{\%}forMS; P=.027). In subgroup analyses of ruptured and unruptured AVMs, no significant differences between the primary outcomes were observed. CONCLUSION: For patients with comparable AVMs, MS and SRS afford similar rates of deficit-free obliteration. Nidal obliteration is more frequently achieved with MS, but this intervention also incurs a greater risk of new permanent neurological deficit.",
author = "Chen, {Ching Jen} and Dale Ding and Wang, {Tony R.} and Buell, {Thomas J.} and Adeel Ilyas and Natasha Ironside and Lee, {Cheng Chia} and Kalani, {M. Yashar} and Park, {Min S.} and Liu, {Kenneth C.} and Sheehan, {Jason P.}",
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Chen, CJ, Ding, D, Wang, TR, Buell, TJ, Ilyas, A, Ironside, N, Lee, CC, Kalani, MY, Park, MS, Liu, KC & Sheehan, JP 2019, 'Microsurgery Versus Stereotactic Radiosurgery for Brain Arteriovenous Malformations: A Matched Cohort Study', Clinical Neurosurgery, vol. 84, no. 3, pp. 696-707. https://doi.org/10.1093/neuros/nyy174

Microsurgery Versus Stereotactic Radiosurgery for Brain Arteriovenous Malformations : A Matched Cohort Study. / Chen, Ching Jen; Ding, Dale; Wang, Tony R.; Buell, Thomas J.; Ilyas, Adeel; Ironside, Natasha; Lee, Cheng Chia; Kalani, M. Yashar; Park, Min S.; Liu, Kenneth C.; Sheehan, Jason P.

In: Clinical Neurosurgery, Vol. 84, No. 3, 01.03.2019, p. 696-707.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Microsurgery Versus Stereotactic Radiosurgery for Brain Arteriovenous Malformations

T2 - A Matched Cohort Study

AU - Chen, Ching Jen

AU - Ding, Dale

AU - Wang, Tony R.

AU - Buell, Thomas J.

AU - Ilyas, Adeel

AU - Ironside, Natasha

AU - Lee, Cheng Chia

AU - Kalani, M. Yashar

AU - Park, Min S.

AU - Liu, Kenneth C.

AU - Sheehan, Jason P.

PY - 2019/3/1

Y1 - 2019/3/1

N2 - BACKGROUND: Microsurgery (MS) and stereotactic radiosurgery (SRS) remain the preferred interventions for the curative treatment of brain arteriovenous malformations (AVM), but their relative efficacy remains incompletely defined. OBJECTIVE: To compare the outcomes of MS to SRS for AVMs through a retrospective, matched cohort study. METHODS: We evaluated institutional databases of AVM patients who underwent MS and SRS. MS-treated patients were matched, in a 1:1 ratio based on patient and AVM characteristics, to SRS-treated patients. Statistical analyses were performed to compare outcomes data between the 2 cohorts. The primary outcome was defined as AVM obliteration without a new permanent neurological deficit. RESULTS: The matched MS and SRS cohorts were each comprised of 59 patients. Both radiological (85 vs 11 mo; P < .001) and clinical (92 vs 12 mo; P < .001) follow-up were significantly longer for the SRS cohort. The primary outcome was achieved in 69% of each cohort. The MS cohort had a significantly higher obliteration rate (98% vs 72%; P = .001), but also had a significantly higher rate of new permanent deficit (31% vs 10%; P= .011). The post-treatment hemorrhage rate was significantly higher for the SRS cohort (10% for SRS vs 0%forMS; P=.027). In subgroup analyses of ruptured and unruptured AVMs, no significant differences between the primary outcomes were observed. CONCLUSION: For patients with comparable AVMs, MS and SRS afford similar rates of deficit-free obliteration. Nidal obliteration is more frequently achieved with MS, but this intervention also incurs a greater risk of new permanent neurological deficit.

AB - BACKGROUND: Microsurgery (MS) and stereotactic radiosurgery (SRS) remain the preferred interventions for the curative treatment of brain arteriovenous malformations (AVM), but their relative efficacy remains incompletely defined. OBJECTIVE: To compare the outcomes of MS to SRS for AVMs through a retrospective, matched cohort study. METHODS: We evaluated institutional databases of AVM patients who underwent MS and SRS. MS-treated patients were matched, in a 1:1 ratio based on patient and AVM characteristics, to SRS-treated patients. Statistical analyses were performed to compare outcomes data between the 2 cohorts. The primary outcome was defined as AVM obliteration without a new permanent neurological deficit. RESULTS: The matched MS and SRS cohorts were each comprised of 59 patients. Both radiological (85 vs 11 mo; P < .001) and clinical (92 vs 12 mo; P < .001) follow-up were significantly longer for the SRS cohort. The primary outcome was achieved in 69% of each cohort. The MS cohort had a significantly higher obliteration rate (98% vs 72%; P = .001), but also had a significantly higher rate of new permanent deficit (31% vs 10%; P= .011). The post-treatment hemorrhage rate was significantly higher for the SRS cohort (10% for SRS vs 0%forMS; P=.027). In subgroup analyses of ruptured and unruptured AVMs, no significant differences between the primary outcomes were observed. CONCLUSION: For patients with comparable AVMs, MS and SRS afford similar rates of deficit-free obliteration. Nidal obliteration is more frequently achieved with MS, but this intervention also incurs a greater risk of new permanent neurological deficit.

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U2 - 10.1093/neuros/nyy174

DO - 10.1093/neuros/nyy174

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AN - SCOPUS:85061575796

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SP - 696

EP - 707

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