Stereotactic Radiosurgery With vs. Without Prior Embolization for Brain Arteriovenous Malformations: A Propensity Score Matching Analysis

Abstract

Objective: Whether partial embolization could facilitate the post-stereotactic radiosurgery (SRS) obliteration for brain arteriovenous malformations (bAVMs) remains controversial. We performed this study to compare the outcomes of SRS with and without prior embolization for bAVMs.Methods: We retrospectively reviewed the Beijing Tiantan AVMs prospective registration research database from September 2011 to October 2014. Patients were categorized into two groups, combined upfront embolization and SRS (Em+SRS group) and SRS alone (SRS group), and we performed a propensity score matching analysis based on pre-embolization baseline characteristics; the matched groups each comprised 76 patients.Results: The obliteration rate was similar between SRS and Em+SRS (44.7 vs. 31.6%; OR, 1.754; 95% CI, 0.905–3.401; p = 0.096). However, the SRS group was superior to the Em+SRS group in terms of cumulative obliteration rate at a follow-up of 5 years (HR,1.778; 95% CI, 1.017–3.110; p = 0.033). The secondary outcomes, including functional state, post-SRS hemorrhage, all-cause mortality, and edema or cyst formation were similar between the matched cohorts. In the ruptured subgroup, the SRS group could achieve higher obliteration rate than Em+SRS group (56.5 vs. 31.9%; OR, 2.773; 95% CI, 1.190–6.464; p = 0.018). The cumulative obliteration rate at 5 years was also higher in the SRS group (64.5 vs. 41.3%; HR, 2.012; 95% CI, 1.037–3.903; p = 0.038), and the secondary outcomes were also similar between the matched cohorts.Conclusion: Although there was no significant difference in the overall obliteration rate between the two strategies, this study suggested that pre-SRS embolization may have a negative effect on post-SRS obliteration. Furthermore, the obliteration rates of the SRS only strategy was significantly higher than that of the Em+SRS strategy in the ruptured cohort, while no such phenomenon was found in the unruptured cohort.

Association of embolization with long-term outcomes in brain arteriovenous malformations: a propensity score-matched analysis using nationwide multicenter prospective registry data

“…A comprehensive protocol for data quality management in the MATCH registry was demonstrated in Supplemental Methods, Supplemental Digital Content 2, http://links.lww.com/JS9/A574 . Previous studies have demonstrated the database’s validity and quality for research 5 , 17 . This study was carried out according to the guideline of the 1964 Helsinki Declaration and was approved by the institutional ethics committee (IRB approval number: KY 2020-003-01).…”

“…Endovascular embolization was typically performed as an adjunct to microsurgery or stereotactic radiosurgery (SRS) for AVMs to facilitate safer dissection of the nidus in microsurgery or reduce the nidus volume to improve the efficacy of SRS 4 , 5 . A growing body of literature has recently discussed curative embolization as a stand-alone treatment in selected lesions, with the advantages of minimal invasiveness and less procedures 4 , 6 – 8 .…”

Predictors of radiation-induced changes in arteriovenous malformation patients undergoing radiosurgery: Insights from a Malaysian linear accelerator cohort

“…[24] Examining RIC severity, our study revealed that 25.3% were classified as Grade I, 13.8% as Grade II, and [26] While the previous studies have suggested an adverse impact of prior embolization on RIC development, our study did not find a significant association. [21,26,32] is discrepancy might stem from the multifactorial and complex nature of the relationship between AVM embolization and RIC development, as indicated by recent studies by Lee et al and Yan et al [28,47]…”

Predicting Factors of the Outcome of Cerebral AVMs Treated with Endovascular Embolization Followed by Gamma Knife Radiosurgery

“…Conservative approach with the risk of hemorrhage, occurrence of seizure or neurological deficit [8][9][10] .…”