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

Basel Musmar; Nimer Adeeb; Hammam Abdalrazeq; Hamza Adel Salim; Joanna Roy; Stavropoula I. Tjoumakaris; Sandeep Kandregula; Christopher S. Ogilvy; Douglas Kondziolka; Jason P. Sheehan; Adam A. Dmytriw; Assala Aslan; Pious Patel; Matthews Lan; Michael P. Baldassari; Sravanthi Koduri; Elias Atallah; Hussein Zeineddine; Mary Katharine Pontarelli; Hussam Abou-Al-Shaar; Kareem El Naamani; Ahmed Abdelsalam; Natasha Ironside; Deepak Kumbhare; Sanjeev Gummadi; Mustafa Baskaya; Cagdas Ataoglu; Finn Mccarthy; Anthony Sanchez-Forteza; Muhammed Amir Essibayi; Abdullah Keles; Sandeep Muram; Daniel Sconzo; Howard Riina; Arwin Rezai; Omar Alwakaa; Salem M. Tos; Georgios Mantziaris; Min S. Park; Sahin Hanalioglu; Ufuk Erginoglu; Johannes Pöppe; Rajeev D. Sen; Christoph J. Griessenauer; Maria Isabel Ocampo-Navia; Diego A. Devia; Wilfran Perez-Mendez; Juan C. Puentes; Rahim Abo Kasem; Alejandro M. Spiotta; Ajit S. Puri; Jasmeet Singh; Anna Luisa Kuhn; Jan Karl Burkhardt; Robert M. Starke; Laligam N. Sekhar; Michael Levitt; David Altschul; Neil Haranhalli; Malia Mcavoy; Marah Eltiti; Abdallah Abushehab; Paul Foreman; Hakeem J. Shakir; Osama O. Zaidat; Mohammad Almajali; Marcella Ruppert-Gomez; Alfred Pokmeng See; Adib A. Abla; Christopher J. Stapleton; Aashay Patel; Andrew Nguyen; Matthew J. Koch; Visish M. Srinivasan; Peng Roc Chen; Spiros Blackburn; Rabab Alshahrani; M. Reid Gooch; Robert H. Rosenwasser; Ketan R. Bulsara; Peter Kan; Louis J. Kim; Omar Choudhri; Bryan Pukenas; Davide Simonato; Yan Lin Li; Ali Alaraj; Maurizio Fuschi; Aman B. Patel; Amey Savardekar; Christina Notarianni; Hugo H. Cuellar; Michael T. Lawton; Bharat Guthikonda; Jacques Morcos; Pascal Jabbour

doi:10.1136/jnis-2025-023873

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

Basel Musmar
, Nimer Adeeb
, Hammam Abdalrazeq
, Hamza Adel Salim
, Joanna Roy
, Stavropoula I. Tjoumakaris
, Sandeep Kandregula
, Christopher S. Ogilvy
, Douglas Kondziolka
, Jason P. Sheehan
, Adam A. Dmytriw
, Assala Aslan
, Pious Patel
, Matthews Lan
, Michael P. Baldassari
, Sravanthi Koduri
, Elias Atallah
, Hussein Zeineddine
, Mary Katharine Pontarelli
, Hussam Abou-Al-Shaar

Kareem El Naamani, Ahmed Abdelsalam, Natasha Ironside, Deepak Kumbhare, Sanjeev Gummadi, Mustafa Baskaya, Cagdas Ataoglu, Finn Mccarthy, Anthony Sanchez-Forteza, Muhammed Amir Essibayi, Abdullah Keles, Sandeep Muram, Daniel Sconzo, Howard Riina, Arwin Rezai, Omar Alwakaa, Salem M. Tos, Georgios Mantziaris, Min S. Park, Sahin Hanalioglu, Ufuk Erginoglu, Johannes Pöppe, Rajeev D. Sen, Christoph J. Griessenauer, Maria Isabel Ocampo-Navia, Diego A. Devia, Wilfran Perez-Mendez, Juan C. Puentes, Rahim Abo Kasem, Alejandro M. Spiotta, Ajit S. Puri, Jasmeet Singh, Anna Luisa Kuhn, Jan Karl Burkhardt, Robert M. Starke, Laligam N. Sekhar, Michael Levitt, David Altschul, Neil Haranhalli, Malia Mcavoy, Marah Eltiti, Abdallah Abushehab, Paul Foreman, Hakeem J. Shakir, Osama O. Zaidat, Mohammad Almajali, Marcella Ruppert-Gomez, Alfred Pokmeng See, Adib A. Abla, Christopher J. Stapleton, Aashay Patel, Andrew Nguyen, Matthew J. Koch, Visish M. Srinivasan, Peng Roc Chen, Spiros Blackburn, Rabab Alshahrani, M. Reid Gooch, Robert H. Rosenwasser, Ketan R. Bulsara, Peter Kan, Louis J. Kim, Omar Choudhri, Bryan Pukenas, Davide Simonato, Yan Lin Li, Ali Alaraj, Maurizio Fuschi, Aman B. Patel, Amey Savardekar, Christina Notarianni, Hugo H. Cuellar, Michael T. Lawton, Bharat Guthikonda, Jacques Morcos, Pascal Jabbour

Neurosurgery

Research output: Contribution to journal › Article › peer-review

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.

Original language	English (US)
Journal	Journal of neurointerventional surgery
DOIs	https://doi.org/10.1136/jnis-2025-023873
State	Accepted/In press - 2025

Keywords

Arteriovenous Malformation

ASJC Scopus subject areas

Surgery
Clinical Neurology

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Musmar, B., Adeeb, N., Abdalrazeq, H., Salim, H. A., Roy, J., Tjoumakaris, S. I., Kandregula, S., Ogilvy, C. S., Kondziolka, D., Sheehan, J. P., Dmytriw, A. A., Aslan, A., Patel, P., Lan, M., Baldassari, M. P., Koduri, S., Atallah, E., Zeineddine, H., Pontarelli, M. K., ... Jabbour, P. (Accepted/In press). 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. Journal of neurointerventional surgery. https://doi.org/10.1136/jnis-2025-023873

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. / Musmar, Basel; Adeeb, Nimer; Abdalrazeq, Hammam et al.
In: Journal of neurointerventional surgery, 2025.

Research output: Contribution to journal › Article › peer-review

Musmar, B, Adeeb, N, Abdalrazeq, H, Salim, HA, Roy, J, Tjoumakaris, SI, Kandregula, S, Ogilvy, CS, Kondziolka, D, Sheehan, JP, Dmytriw, AA, Aslan, A, Patel, P, Lan, M, Baldassari, MP, Koduri, S, Atallah, E, Zeineddine, H, Pontarelli, MK, Abou-Al-Shaar, H, El Naamani, K, Abdelsalam, A, Ironside, N, Kumbhare, D, Gummadi, S, Baskaya, M, Ataoglu, C, Mccarthy, F, Sanchez-Forteza, A, Essibayi, MA, Keles, A, Muram, S, Sconzo, D, Riina, H, Rezai, A, Alwakaa, O, Tos, SM, Mantziaris, G, Park, MS, Hanalioglu, S, Erginoglu, U, Pöppe, J, Sen, RD, Griessenauer, CJ, Ocampo-Navia, MI, Devia, DA, Perez-Mendez, W, Puentes, JC, Abo Kasem, R, Spiotta, AM, Puri, AS, Singh, J, Kuhn, AL, Burkhardt, JK, Starke, RM, Sekhar, LN, Levitt, M, Altschul, D, Haranhalli, N, Mcavoy, M, Eltiti, M, Abushehab, A, Foreman, P, Shakir, HJ, Zaidat, OO, Almajali, M, Ruppert-Gomez, M, See, AP, Abla, AA, Stapleton, CJ, Patel, A, Nguyen, A, Koch, MJ, Srinivasan, VM, Chen, PR, Blackburn, S, Alshahrani, R, Gooch, MR, Rosenwasser, RH, Bulsara, KR, Kan, P, Kim, LJ, Choudhri, O, Pukenas, B, Simonato, D, Li, YL, Alaraj, A, Fuschi, M, Patel, AB, Savardekar, A, Notarianni, C, Cuellar, HH, Lawton, MT, Guthikonda, B, Morcos, J & Jabbour, P 2025, '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', Journal of neurointerventional surgery. https://doi.org/10.1136/jnis-2025-023873

@article{850b1416bac346ef8556a6f9208864a4,

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",

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.",

keywords = "Arteriovenous Malformation",

author = "Basel Musmar and Nimer Adeeb and Hammam Abdalrazeq and Salim, \{Hamza Adel\} and Joanna Roy and Tjoumakaris, \{Stavropoula I.\} and Sandeep Kandregula and Ogilvy, \{Christopher S.\} and Douglas Kondziolka and Sheehan, \{Jason P.\} and Dmytriw, \{Adam A.\} and Assala Aslan and Pious Patel and Matthews Lan and Baldassari, \{Michael P.\} and Sravanthi Koduri and Elias Atallah and Hussein Zeineddine and Pontarelli, \{Mary Katharine\} and Hussam Abou-Al-Shaar and \{El Naamani\}, Kareem and Ahmed Abdelsalam and Natasha Ironside and Deepak Kumbhare and Sanjeev Gummadi and Mustafa Baskaya and Cagdas Ataoglu and Finn Mccarthy and Anthony Sanchez-Forteza and Essibayi, \{Muhammed Amir\} and Abdullah Keles and Sandeep Muram and Daniel Sconzo and Howard Riina and Arwin Rezai and Omar Alwakaa and Tos, \{Salem M.\} and Georgios Mantziaris and Park, \{Min S.\} and Sahin Hanalioglu and Ufuk Erginoglu and Johannes P{\"o}ppe and Sen, \{Rajeev D.\} and Griessenauer, \{Christoph J.\} and Ocampo-Navia, \{Maria Isabel\} and Devia, \{Diego A.\} and Wilfran Perez-Mendez and Puentes, \{Juan C.\} and \{Abo Kasem\}, Rahim and Spiotta, \{Alejandro M.\} and Puri, \{Ajit S.\} and Jasmeet Singh and Kuhn, \{Anna Luisa\} and Burkhardt, \{Jan Karl\} and Starke, \{Robert M.\} and Sekhar, \{Laligam N.\} and Michael Levitt and David Altschul and Neil Haranhalli and Malia Mcavoy and Marah Eltiti and Abdallah Abushehab and Paul Foreman and Shakir, \{Hakeem J.\} and Zaidat, \{Osama O.\} and Mohammad Almajali and Marcella Ruppert-Gomez and See, \{Alfred Pokmeng\} and Abla, \{Adib A.\} and Stapleton, \{Christopher J.\} and Aashay Patel and Andrew Nguyen and Koch, \{Matthew J.\} and Srinivasan, \{Visish M.\} and Chen, \{Peng Roc\} and Spiros Blackburn and Rabab Alshahrani and Gooch, \{M. Reid\} and Rosenwasser, \{Robert H.\} and Bulsara, \{Ketan R.\} and Peter Kan and Kim, \{Louis J.\} and Omar Choudhri and Bryan Pukenas and Davide Simonato and Li, \{Yan Lin\} and Ali Alaraj and Maurizio Fuschi and Patel, \{Aman B.\} and Amey Savardekar and Christina Notarianni and Cuellar, \{Hugo H.\} and Lawton, \{Michael T.\} and Bharat Guthikonda and Jacques Morcos and Pascal Jabbour",

note = "Publisher Copyright: {\textcopyright} Author(s) (or their employer(s)) 2025. No commercial re-use. See rights and permissions. Published by BMJ Group.",

year = "2025",

doi = "10.1136/jnis-2025-023873",

language = "English (US)",

journal = "Journal of neurointerventional surgery",

issn = "1759-8478",

publisher = "BMJ Publishing Group",

}

TY - JOUR

T1 - Safety and efficacy of preoperative embolization in the treatment of brain arteriovenous malformations with perinidal aneurysms and single draining vein

T2 - a multicenter study with propensity score-weighting

AU - Musmar, Basel

AU - Adeeb, Nimer

AU - Abdalrazeq, Hammam

AU - Salim, Hamza Adel

AU - Roy, Joanna

AU - Tjoumakaris, Stavropoula I.

AU - Kandregula, Sandeep

AU - Ogilvy, Christopher S.

AU - Kondziolka, Douglas

AU - Sheehan, Jason P.

AU - Dmytriw, Adam A.

AU - Aslan, Assala

AU - Patel, Pious

AU - Lan, Matthews

AU - Baldassari, Michael P.

AU - Koduri, Sravanthi

AU - Atallah, Elias

AU - Zeineddine, Hussein

AU - Pontarelli, Mary Katharine

AU - Abou-Al-Shaar, Hussam

AU - El Naamani, Kareem

AU - Abdelsalam, Ahmed

AU - Ironside, Natasha

AU - Kumbhare, Deepak

AU - Gummadi, Sanjeev

AU - Baskaya, Mustafa

AU - Ataoglu, Cagdas

AU - Mccarthy, Finn

AU - Sanchez-Forteza, Anthony

AU - Essibayi, Muhammed Amir

AU - Keles, Abdullah

AU - Muram, Sandeep

AU - Sconzo, Daniel

AU - Riina, Howard

AU - Rezai, Arwin

AU - Alwakaa, Omar

AU - Tos, Salem M.

AU - Mantziaris, Georgios

AU - Park, Min S.

AU - Hanalioglu, Sahin

AU - Erginoglu, Ufuk

AU - Pöppe, Johannes

AU - Sen, Rajeev D.

AU - Griessenauer, Christoph J.

AU - Ocampo-Navia, Maria Isabel

AU - Devia, Diego A.

AU - Perez-Mendez, Wilfran

AU - Puentes, Juan C.

AU - Abo Kasem, Rahim

AU - Spiotta, Alejandro M.

AU - Puri, Ajit S.

AU - Singh, Jasmeet

AU - Kuhn, Anna Luisa

AU - Burkhardt, Jan Karl

AU - Starke, Robert M.

AU - Sekhar, Laligam N.

AU - Levitt, Michael

AU - Altschul, David

AU - Haranhalli, Neil

AU - Mcavoy, Malia

AU - Eltiti, Marah

AU - Abushehab, Abdallah

AU - Foreman, Paul

AU - Shakir, Hakeem J.

AU - Zaidat, Osama O.

AU - Almajali, Mohammad

AU - Ruppert-Gomez, Marcella

AU - See, Alfred Pokmeng

AU - Abla, Adib A.

AU - Stapleton, Christopher J.

AU - Patel, Aashay

AU - Nguyen, Andrew

AU - Koch, Matthew J.

AU - Srinivasan, Visish M.

AU - Chen, Peng Roc

AU - Blackburn, Spiros

AU - Alshahrani, Rabab

AU - Gooch, M. Reid

AU - Rosenwasser, Robert H.

AU - Bulsara, Ketan R.

AU - Kan, Peter

AU - Kim, Louis J.

AU - Choudhri, Omar

AU - Pukenas, Bryan

AU - Simonato, Davide

AU - Li, Yan Lin

AU - Alaraj, Ali

AU - Fuschi, Maurizio

AU - Patel, Aman B.

AU - Savardekar, Amey

AU - Notarianni, Christina

AU - Cuellar, Hugo H.

AU - Lawton, Michael T.

AU - Guthikonda, Bharat

AU - Morcos, Jacques

AU - Jabbour, Pascal

PY - 2025

Y1 - 2025

N2 - 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.

AB - 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.

KW - Arteriovenous Malformation

UR - https://www.scopus.com/pages/publications/105013964290

UR - https://www.scopus.com/pages/publications/105013964290#tab=citedBy

U2 - 10.1136/jnis-2025-023873

DO - 10.1136/jnis-2025-023873

M3 - Article

C2 - 40846482

AN - SCOPUS:105013964290

SN - 1759-8478

JO - Journal of neurointerventional surgery

JF - Journal of neurointerventional surgery

ER -

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

Abstract

Keywords

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