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<p>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 <i>p</i> = 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; <i>p</i> = 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; <i>p</i> = 0.042). Increasing age (OR 1.08 per year, 95% CI 1.02–1.13; <i>p</i> = 0.004) and pre-existing functional disability (OR 6.53, 95% CI 1.63–26.22; <i>p</i> = 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. </p>

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International multi-center study to quantify the effect of deep venous drainage after surgical resection of Spetzler-Martin Grade II-III brain arteriovenous malformations

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  • 发表日期：

    2026年5月22日

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  • Avi A. Gajjar,
  • Rashad Jabarkheel,
  • Mohamed M. Salem,
  • Basel Musmar,
  • Sandeep Kandregula,
  • Hammam Abdalrazeq,
  • Nimer Adeeb,
  • Assala Aslan,
  • Nathan Ramachandran,
  • Stavropoula I Tjoumakaris,
  • Hamza Adel Salim,
  • Adam A. Dmytriw,
  • Christopher S. Ogilvy,
  • Mustafa K. Baskaya,
  • Douglas Kondziolka,
  • Jason Sheehan,
  • Howard Riina,
  • Abdallah Abushehab,
  • Kareem El Naamani,
  • Najib Muhammad,
  • Ahmed Abdelsalam,
  • Natasha Ironside,
  • Deepak Kumbhare,
  • Sanjeev Gummadi,
  • Cagdas Ataoglu,
  • Muhammed Amir Essibayi,
  • Abdullah Keles,
  • Sandeep Muram,
  • Daniel Sconzo,
  • Arwin Rezai,
  • Omar Alwakaa,
  • Pierce Davis,
  • Salem M Tos,
  • Ufuk Erginoglu,
  • Johannes Pöppe,
  • Rajeev D. Sen,
  • Alan S. Boulos,
  • John C. Dalfino,
  • Christoph J. Griessenauer,
  • Robert M. Starke,
  • Laligam N. Sekhar,
  • Michael R. Levitt,
  • David J. Altschul,
  • Neil Haranhalli,
  • Malia McAvoy,
  • Hussein A. Zeineddine,
  • Adib A. Abla,
  • Saman Sizdahkhani,
  • Sravanthi Koduri,
  • M. Reid Gooch,
  • Robert H. Rosenwasser,
  • Christopher Stapleton,
  • Matthew Koch,
  • Peng R. Chen,
  • Spiros Blackburn,
  • Ketan Bulsara,
  • Louis J. Kim,
  • Omar Choudhri,
  • Bryan Pukenas,
  • Joshua S. Catapano,
  • Darren Orbach,
  • Edward Smith,
  • Pascal J. Mosimann,
  • Alexandra R. Paul,
  • Pascal Jabbour,
  • Ali Alaraj,
  • Mohammad A. Aziz-Sultan,
  • Aman B. Patel,
  • Amey Savardekar,
  • Christina Notarianni,
  • Hugo H. Cuellar,
  • Bharat Guthikonda,
  • Jacques Morcos,
  • Michael Lawton,
  • Jan-Karl Burkhardt,
  • Visish M. Srinivasan

摘要

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.