Long-term outcomes of microsurgery and stereotactic radiosurgery as the first-line treatment for arteriovenous malformations: a propensity score-matched analysis using nationwide multicenter prospective registry data

Heze Han; Dezhi Gao; Li Ma; Ruinan Li; Zhipeng Li; Haibin Zhang; Kexin Yuan; Ke Wang; Yukun Zhang; Yang Zhao; Weitao Jin; Hengwei Jin; Xiangyu Meng; Debin Yan; Runting Li; Fa Lin; Qiang Hao; Hao Wang; Xun Ye; Shuai Kang; Jun Pu; Zhiyong Shi; Xiaofeng Chao; Zhengfeng Lin; Junlin Lu; Youxiang Li; Yuanli Zhao; Shibin Sun; Yu Chen; Xiaolin Chen; Shuo Wang; Registry of Multimodality Treatment for Brain Arteriovenous Malformation in Mainland China (MATCH)

doi:10.1097/JS9.0000000000000751

Long-term outcomes of microsurgery and stereotactic radiosurgery as the first-line treatment for arteriovenous malformations: a propensity score-matched analysis using nationwide multicenter prospective registry data

Int J Surg. 2023 Dec 1;109(12):3983-3992. doi: 10.1097/JS9.0000000000000751.

Authors

Heze Han^{1

2}, Dezhi Gao³, Li Ma^{1

2}, Ruinan Li^{1

2}, Zhipeng Li^{1

2}, Haibin Zhang^{1

2}, Kexin Yuan^{1

2}, Ke Wang^{1

2}, Yukun Zhang⁴, Yang Zhao⁴, Weitao Jin⁴, Hengwei Jin⁵, Xiangyu Meng⁶, Debin Yan⁷, Runting Li^{1

2}, Fa Lin^{1

2}, Qiang Hao^{1

2}, Hao Wang^{1

2}, Xun Ye^{1

2}, Shuai Kang^{1

2}, Jun Pu⁸, Zhiyong Shi⁹, Xiaofeng Chao¹⁰, Zhengfeng Lin¹¹, Junlin Lu¹², Youxiang Li⁵, Yuanli Zhao^{1

2}, Shibin Sun³, Yu Chen^{1

2}, Xiaolin Chen^{1

2}, Shuo Wang^{1

2}; Registry of Multimodality Treatment for Brain Arteriovenous Malformation in Mainland China (MATCH)

Affiliations

¹ Department of Neurosurgery.
² China National Clinical Research Center for Neurological Diseases, Beijing.
³ Department of Gamma-Knife Center.
⁴ Department of Neurosurgery, Peking University International Hospital, Peking University.
⁵ Department of Interventional Neuroradiology, Beijing Tiantan Hospital, Capital Medical University.
⁶ Department of Neurosurgery, The First Hospital of Hebei Medical University, Hebei Medical University, Shijiazhuang.
⁷ Department of Neurosurgery, Shanxi Provincial People's Hospital, Shanxi.
⁸ First Department of Neurosurgery, The Second Affiliated Hospital of Kunming Medical University, Kunming.
⁹ Department of Neurosurgery, Nanjing Drum Tower Hospital, Affiliated to Nanjing University, Nanjing, Jiangsu.
¹⁰ Department of Neurosurgery, The Second Affiliated Hospital of Xuzhou Medical University, Jiangsu.
¹¹ Department of Neurosurgery, The First People's Hospital of Qinzhou, Guangxi.
¹² Department of Neurosurgery, West China Hospital, Sichuan University, Chengdu, Sichuan, People's Republic of China.

Abstract

Background: This study aimed to compare the risk and benefit profile of microsurgery (MS) and stereotactic radiosurgery (SRS) as the first-line treatment for unruptured and ruptured arteriovenous malformations (AVMs).

Materials and methods: The authors included AVMs underwent MS or SRS as the first-line treatment from a nationwide prospective multicenter registry in mainland China. The authors used propensity score-matched methods to balance baseline characteristics between the MS and SRS groups. The primary outcomes were long-term hemorrhagic stroke or death, and the secondary outcomes were long-term obliteration and neurological outcomes. Subgroup analyses and sensitivity analyses with different study designs were performed to confirm the stability of our findings.

Results: Of the 4286 consecutive AVMs in the registry from August 2011 to December 2021; 1604 patients were eligible. After matching, 244 unruptured and 442 ruptured AVMs remained for the final analysis. The mean follow-up duration was 7.0 years in the unruptured group and 6.1 years in the ruptured group. In the comparison of primary outcomes, SRS was associated with a higher risk of hemorrhagic stroke or death both in the unruptured and ruptured AVMs (unruptured: hazard ratio 4.06, 95% CI: 1.15-14.41; ruptured: hazard ratio 4.19, 95% CI: 1.58-11.15). In terms of the secondary outcomes, SRS was also observed to have a significant disadvantage in long-term obliteration [unruptured: odds ratio (OR) 0.01, 95% CI: 0.00-0.04; ruptured: OR 0.09, 95% CI: 0.05-0.15]. However, it should be noted that SRS may have advantages in preventing neurofunctional decline (unruptured: OR 0.56, 95% CI: 0.27-1.14; ruptured: OR 0.41, 95% CI: 0.23-0.76). The results of subgroup analyses and sensitivity analyses were consistent in trend but with slightly varied powers.

Conclusions: This clinical practice-based real-world study comprehensively compared MS and SRS for AVMs with long-term outcomes. MS is more effective in preventing future hemorrhage or death and achieving obliteration, while the risk of neurofunctional decline should not be ignored.

Trial registration: ClinicalTrials.gov NCT04572568.

Publication types

Multicenter Study

MeSH terms

Follow-Up Studies
Hemorrhagic Stroke* / complications
Hemorrhagic Stroke* / surgery
Humans
Intracranial Arteriovenous Malformations* / complications
Intracranial Arteriovenous Malformations* / surgery
Microsurgery / adverse effects
Propensity Score
Radiosurgery* / adverse effects
Radiosurgery* / methods
Retrospective Studies
Routinely Collected Health Data
Treatment Outcome

Associated data

ClinicalTrials.gov/NCT04572568