Document Type
Article
Publication Date
8-31-2026
Abstract
INTRODUCTION: Patient and arteriovenous malformation (AVM) characteristics that portend success after treatment for low-grade brain AVMs remain unknown.
PATIENTS AND METHODS: We utilised the MISTA multicentre registry to identify patients with Spetzler-Martin (SM) grade I or II AVMs treated with stand-alone curative-intent intervention (resection, stereotactic radiosurgery [SRS] or endovascular embolisation). Bivariate and multivariable analyses were performed to identify patient and AVM characteristics predictive of complete obliteration or favourable outcome (complete obliteration without new permanent deficit or post-treatment haemorrhage).
RESULTS: A total of 522 patients were included (292 microsurgery, 152 SRS, 78 embolisation). Complete obliteration rates differed between microsurgery (95.9%), SRS (75.0%) and embolisation (71.8%) (P < .001); among patients classified as cured, digital subtraction angiography (DSA) confirmed obliteration in 96.1%, 75.9% and 52.4%, respectively. Favourable outcome was achieved in 89.4%, 64.5% and 67.9% (P < .001). In adjusted models for obliteration, elderly age (odds ratio [OR] 0.49, P = .022), larger nidus (OR 0.64, P = .005) and compacted morphology (OR 1.93, P = .019) were independent predictors overall; paediatric age predicted incomplete obliteration after microsurgery (OR 0.05, P = .045), and elderly age (OR 0.19, P = .001) and larger nidus (OR 0.59, P = .015) after SRS. For favourable outcome, SM grade II overall (adjusted OR [aOR] 0.58, P = .031) and elderly age after SRS (aOR 0.31, P = .019) were independent negative predictors.
DISCUSSION: Low-grade AVMs showed high rates of complete obliteration, though DSA-confirmed rates were substantially lower after embolisation, underscoring the importance of angiographic confirmation.
CONCLUSION: The predictors identified in this study may help guide management when 2 or 3 of the primary treatment options carry clinical equipoise.
Recommended Citation
Fuentes, Angelica; Tos, Salem; Ironside, Natasha; Mantziaris, Georgios; Shinya, Yuki; Musmar, Basel; Salim, Hamza Adel; Adeeb, Nimer; Ogilvy, Christopher; Kondziolka, Douglas; Alaraj, Ali; Park, Min; Dmytriw, Adam; Zeineddine, Hussein; Mccarthy, Finn; Abou-Al-Shaar, Hussam; Abdelsalam, Ahmed; Baskaya, Mustafa; Ataoglu, Cagdas; Sanchez-Forteza, Anthony; Essibayi, Muhammed Amir; Keles, Abdullah; Muram, Sandeep; Riina, Howard; Rezai, Arwin; Hanalioglu, Sahin; Erginoglu, Ufuk; Pöppe, Johannes; Simonato, Davide; Li, Yan-Lin; Kandregula, Sandeep; Lakhani, Dhairya; Griessenauer, Christoph; Kasem, Rahim Abo; Spiotta, Alejandro; Puri, Ajit; Singh, Jasmeet; Kuhn, Anna Luisa; Burkhardt, Jan Karl; Starke, Robert; Sekhar, Laligam; Levitt, Michael; Altschul, David; Haranhalli, Neil; McAvoy, Malia; Foreman, Paul; Zaidat, Osama; AlMajali, Mohammad; Shakir, Hakeem; See, Alfred Pokmeng; Abla, Adib; Patel, Aashay; Nguyen, Andrew; Koch, Matthew; Srinivasan, Visish; Chen, Peng Roc; Blackburn, Spiros; Bulsara, Ketan; Kan, Peter; Kim, Louis; Choudhri, Omar; Tjoumakaris, Stavropoula; Jabbour, Pascal; Savardekar, Amey; Cuellar, Hugo; Lawton, Michael; Guthikonda, Bharat; Morcos, Jacques; and Sheehan, Jason, "Predictors of Complete Obliteration and Favourable Outcome After Single-Modality Treatment for Low-Grade Arteriovenous Malformations: a Multicentre Study" (2026). Department of Neurology Faculty Papers. Paper 411.
https://jdc.jefferson.edu/neurologyfp/411
Creative Commons License
This work is licensed under a Creative Commons Attribution 4.0 License.
PubMed ID
42673144
Language
English
Comments
This article is the author’s final published version in European stroke journal, Volume 11, Issue 8, 2026, Article number e077471.
The published version is available at https://doi.org/10.1093/esj/aakag103. Copyright © The Author(s) 2026.