Document Type
Article
Publication Date
5-22-2026
Abstract
Deep venous drainage (DVD) is considered a negative prognostic factor in AVM surgery, yet its effect on postoperative functional decline remains incompletely defined. This study evaluates whether DVD predicts worsened functional status after surgical resection of Spetzler-Martin Grade II-III AVMs. This retrospective multicenter study analyzed 129 patients with Spetzler-Martin Grade II-III AVMs across nine centers in North America and Europe who underwent primary surgical resection. We excluded cases with prior endovascular or stereotactic interventions. The primary outcome measured was poor functional status, defined as modified Rankin Scale (mRS) score 3-6 at last follow up. Among 129 patients with Spetzler-Martin Grade II-III AVMs, 38 (29.5%) exhibited deep venous drainage (DVD). Poor functional outcome (mRS ≥ 3) at last follow-up occurred in 14 patients (10.9%). This occurred in 6 of 38 patients with DVD (15.8%) compared with 8 of 91 without DVD (8.8%; Fisher's exact p = 0.244). On univariate Firth-penalized logistic regression, DVD was not significantly associated with poor outcome (OR 1.96, 95% CI 0.65-5.89; p = 0.228). In the primary reduced Firth model adjusting for age and pre-existing functional disability, DVD was independently associated with poor outcome (OR 6.87, 95% CI 1.07-44.20; p = 0.042). Increasing age (OR 1.08 per year, 95% CI 1.02-1.13; p = 0.004) and pre-existing functional disability (OR 6.53, 95% CI 1.63-26.22; p = 0.008) were also independently associated with poor outcome. DVD is associated with functional decline following surgical resection of Spetzler-Martin Grade II-III AVMs after adjustment for age and pre-existing functional disability.
Recommended Citation
Gajjar, Avi A.; Jabarkheel, Rashad; Salem, Mohamed M.; Musmar, Basel; Kandregula, Sandeep; Abdalrazeq, Hammam; Adeeb, Nimer; Aslan, Assala; Ramachandran, Nathan; Tjoumakaris, Stavropoula; Salim, Hamza Adel; Dmytriw, Adam A.; Ogilvy, Christopher S.; Baskaya, Mustafa K.; Kondziolka, Douglas; Sheehan, Jason; Riina, Howard; Abushehab, Abdallah; El Naamani, Kareem; Muhammad, Najib; Abdelsalam, Ahmed; Ironside, Natasha; Kumbhare, Deepak; Gummadi, Sanjeev; Ataoglu, Cagdas; Essibayi, Muhammed Amir; Keles, Abdullah; Muram, Sandeep; Sconzo, Daniel; Rezai, Arwin; Alwakaa, Omar; Davis, Pierce; Tos, Salem M.; Erginoglu, Ufuk; Pöppe, Johannes; Sen, Rajeev D.; Boulos, Alan S.; Dalfino, John C.; Griessenauer, Christoph J.; Starke, Robert M.; Sekhar, Laligam N.; Levitt, Michael R.; Altschul, David J.; Haranhalli, Neil; McAvoy, Malia; Zeineddine, Hussein A.; Abla, Adib A.; Sizdahkhani, Saman; Koduri, Sravanthi; Gooch, Michael R.; Rosenwasswer MD, Robert H.; Stapleton, Christopher; Koch, Matthew; Chen, Peng R.; Blackburn, Spiros; Bulsara, Ketan; Kim, Louis J.; Choudhri, Omar; Pukenas, Bryan; Catapano, Joshua S.; Orbach, Darren; Smith, Edward; Mosimann, Pascal J.; Paul, Alexandra R.; Jabbour, Pascal; Alaraj, Ali; Aziz-Sultan, Mohammad A.; Patel, Aman B.; Savardekar, Amey; Notarianni, Christina; Cuellar, Hugo H.; Guthikonda, Bharat; Morcos, Jacques; Lawton, Michael; Burkhardt, Jan-Karl; and Srinivasan, Visish M., "International Multi-Center Study to Quantify the Effect of Deep Venous Drainage After Surgical Resection of Spetzler-Martin Grade II-III Brain Arteriovenous Malformations" (2026). Department of Neurosurgery Faculty Papers. Paper 306.
https://jdc.jefferson.edu/neurosurgeryfp/306
Creative Commons License
This work is licensed under a Creative Commons Attribution 4.0 License.
PubMed ID
42168675
Language
English
Comments
This article is the author's final published version in Neurosurgical Review, Volume 49, Issue 1, 2026, Article Number 414.
The published version is available at https://doi.org/10.1007/s10143-026-04310-0. Copyright © The Author(s) 2026.