Management of Spetzler-Martin Grade Ⅲ Brain Arteriovenous Malformation

Sunday, May 5, 2024

3:37 PM - 3:39 PM CT

Location: S405a

Presenting Author(s)

Shahab Aldin Sattari, MD

Postdoc Research Fellow
Johns Hopkins

Co-Author(s)

Judy Huang, MD (she/her/hers)

Professor of Neurosurgery
Department of Neurosurgery, The Johns Hopkins University School of Medicine
Baltimore, MD, US
Wuyang Yang, MD (he/him/his)

Resident
Johns Hopkins
Baltimore, Maryland, United States

Disclosure(s):

Shahab Aldin Sattari, MD: No financial relationships to disclose

Judy Huang, MD: No financial relationships to disclose

Introduction: Treatment for brain arteriovenous malformations (bAVMs) aims to obliterate the nidus while preserving the neurofunctional status. Despite recent advancements, optimal management for Spetzler-Martin (SM) grade Ⅲ bAVMs is evolving. This study aim to elucidate management outcomes of SM grade Ⅲ bAVMs.

Methods: Our institutional database was retrieved for patients with SM grade Ⅲ bAVMs. The primary outcome was obliteration without worsened modified Rankin Scale (mRS) (referred to as excellent outcome). Secondary outcomes were hemorrhages, follow-up mRS>2, and mortality

Results: After reviewing 1066 patients, 354 patients with SM grade Ⅲ comprising 164 S1E1V1, 156 S2E1V0, and 34 S2E0V were included. For S1E1V1, multivariable logistic regression determined that surgery (OR=81.238 (15.134-629.049), p< 0.002), and radiosurgery (OR=12.276 (3.796-55.893), p=0.001) predicted higher excellent outcome, while nidus size (OR=0.492 (0.267-0.877), p=0.018) and draining vein varices (OR=0.1922 (0.036-0.735), p=0.027) were associated with lower excellent outcome. Treatment groups were similar in follow-up hemorrhages. However, follow-up mRS>2 was lower with surgery (16.66%) and radiosurgery (17.14%) versus embolization (60%) and conservative management (33.33%) (p=0.038). In addition, mortality was lower with surgery (0%) and radiosurgery (4.7%) versus embolization (40%) and conservative management (22.22%) (p=0.001). For S2E1V0, multivariable logistic regression showed that surgery (OR=4.975 (1.912-14.002), p=0.001) and nidus size (OR=0.461 (0.257-0.782), p=0.005) were associated with higher and lower excellent outcome, respectively. Secondary outcomes were similar between groups. For S2E0V1, surgery tended to be associated with higher excellent outcome (OR=4.000 (0.959-18.625), p=0.063) at univariable logistic regression. Secondary outcomes were similar between groups.

Conclusion : Excellent outcome can be achieved with both surgery and radiosurgery for S1E1V1; however, surgery is more beneficial. With judicious patient selection, surgery can be considered for S2E1V0. Conservative management is still the mainstay for patients with S2E0V1.