Assessing the Role of Preoperative Embolization in the Surgical Management of Cerebral Arteriovenous Malformations

Andrew S. Luksik, Jody Law, Wuyang Yang, Tomas Garzon-Muvdi, Justin Caplan, Geoffrey Colby, Alexander Coon, Rafael J Tamargo, Judy Huang

Research output: Contribution to journalArticle

Abstract

Background Preoperative embolization is established as an advantageous adjunct in multimodality treatment of cerebral arteriovenous malformations (AVMs). However, the benefit of preoperative embolization in AVMs with favorable surgical risk profile is debatable, because it has yet to be supported by evidence in comparative studies. In this study, we assessed outcome of surgically treated patients in a comparative setting. Methods Our institutional AVM database of retrospectively and prospectively collected data between 1990 and 2015 was reviewed. Patients with complete clinical data who underwent surgical resection for AVMs were included. We performed a 1:1 ratio propensity score match for baseline variables that differed between patients with or without preoperative embolization. Differences in surgical risk and outcomes were evaluated between these 2 groups. Results AVM size, eloquence, deep drainage, middle cerebral artery feeder, and ruptured presentation differed significantly between the 2 groups. Forty-eight patients without preoperative embolization were matched to 48 with embolization, with no significant differences in baseline variables or AVM characteristics between the 2 groups. We found no significant differences in AVM obliteration and postoperative modified Rankin Scale (mRS) score between embolized and nonembolized patients, respectively. Change in mRS score from preoperative score was also not significant, although more embolized patients had a decline in mRS score. Secondary outcome measures including duration of surgery (P = 0.172), intraoperative bleeding (P = 0.280), duration of hospitalization (P = 0.368), and postoperative symptoms were also similar between both groups. Conclusions Our data do not support substantial benefit of preoperative embolization for patients with a favorable surgical risk profile. Because of risks and costs with this intervention, the prudent use of preoperative embolization should be individually considered.

Original languageEnglish (US)
Pages (from-to)430-441
Number of pages12
JournalWorld Neurosurgery
Volume104
DOIs
StatePublished - Aug 1 2017

Fingerprint

Intracranial Arteriovenous Malformations
Arteriovenous Malformations
Propensity Score
Middle Cerebral Artery
Drainage
Hospitalization
Outcome Assessment (Health Care)
Databases
Hemorrhage
Costs and Cost Analysis

Keywords

  • Arteriovenous malformation
  • Microsurgery
  • Preoperative embolization

ASJC Scopus subject areas

  • Surgery
  • Clinical Neurology

Cite this

Assessing the Role of Preoperative Embolization in the Surgical Management of Cerebral Arteriovenous Malformations. / Luksik, Andrew S.; Law, Jody; Yang, Wuyang; Garzon-Muvdi, Tomas; Caplan, Justin; Colby, Geoffrey; Coon, Alexander; Tamargo, Rafael J; Huang, Judy.

In: World Neurosurgery, Vol. 104, 01.08.2017, p. 430-441.

Research output: Contribution to journalArticle

Luksik, Andrew S. ; Law, Jody ; Yang, Wuyang ; Garzon-Muvdi, Tomas ; Caplan, Justin ; Colby, Geoffrey ; Coon, Alexander ; Tamargo, Rafael J ; Huang, Judy. / Assessing the Role of Preoperative Embolization in the Surgical Management of Cerebral Arteriovenous Malformations. In: World Neurosurgery. 2017 ; Vol. 104. pp. 430-441.
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N2 - Background Preoperative embolization is established as an advantageous adjunct in multimodality treatment of cerebral arteriovenous malformations (AVMs). However, the benefit of preoperative embolization in AVMs with favorable surgical risk profile is debatable, because it has yet to be supported by evidence in comparative studies. In this study, we assessed outcome of surgically treated patients in a comparative setting. Methods Our institutional AVM database of retrospectively and prospectively collected data between 1990 and 2015 was reviewed. Patients with complete clinical data who underwent surgical resection for AVMs were included. We performed a 1:1 ratio propensity score match for baseline variables that differed between patients with or without preoperative embolization. Differences in surgical risk and outcomes were evaluated between these 2 groups. Results AVM size, eloquence, deep drainage, middle cerebral artery feeder, and ruptured presentation differed significantly between the 2 groups. Forty-eight patients without preoperative embolization were matched to 48 with embolization, with no significant differences in baseline variables or AVM characteristics between the 2 groups. We found no significant differences in AVM obliteration and postoperative modified Rankin Scale (mRS) score between embolized and nonembolized patients, respectively. Change in mRS score from preoperative score was also not significant, although more embolized patients had a decline in mRS score. Secondary outcome measures including duration of surgery (P = 0.172), intraoperative bleeding (P = 0.280), duration of hospitalization (P = 0.368), and postoperative symptoms were also similar between both groups. Conclusions Our data do not support substantial benefit of preoperative embolization for patients with a favorable surgical risk profile. Because of risks and costs with this intervention, the prudent use of preoperative embolization should be individually considered.

AB - Background Preoperative embolization is established as an advantageous adjunct in multimodality treatment of cerebral arteriovenous malformations (AVMs). However, the benefit of preoperative embolization in AVMs with favorable surgical risk profile is debatable, because it has yet to be supported by evidence in comparative studies. In this study, we assessed outcome of surgically treated patients in a comparative setting. Methods Our institutional AVM database of retrospectively and prospectively collected data between 1990 and 2015 was reviewed. Patients with complete clinical data who underwent surgical resection for AVMs were included. We performed a 1:1 ratio propensity score match for baseline variables that differed between patients with or without preoperative embolization. Differences in surgical risk and outcomes were evaluated between these 2 groups. Results AVM size, eloquence, deep drainage, middle cerebral artery feeder, and ruptured presentation differed significantly between the 2 groups. Forty-eight patients without preoperative embolization were matched to 48 with embolization, with no significant differences in baseline variables or AVM characteristics between the 2 groups. We found no significant differences in AVM obliteration and postoperative modified Rankin Scale (mRS) score between embolized and nonembolized patients, respectively. Change in mRS score from preoperative score was also not significant, although more embolized patients had a decline in mRS score. Secondary outcome measures including duration of surgery (P = 0.172), intraoperative bleeding (P = 0.280), duration of hospitalization (P = 0.368), and postoperative symptoms were also similar between both groups. Conclusions Our data do not support substantial benefit of preoperative embolization for patients with a favorable surgical risk profile. Because of risks and costs with this intervention, the prudent use of preoperative embolization should be individually considered.

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