Learning curve and embolisation strategy in single-stage surgery combined embolisation and microsurgery for brain arteriovenous malformations: results from a nationwide multicentre prospective registry study
Objective Single-stage surgery combining embolisation and microsurgery has been increasingly used as a stand-alone procedure to cure complex AVMs. This study aimed to investigate the learning curve and embolisation strategy for single-stage surgery for AVMs.Methods This prospective cohort study used...
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| Series: | Stroke and Vascular Neurology |
| Online Access: | https://svn.bmj.com/content/early/2025/04/07/svn-2025-004051.full |
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| author | Yang Zhao Shuo Wang Li Ma Yu Chen Xiaolin Chen Youxiang Li Yukun Zhang Tengfei Yu Heze Han |
| author_facet | Yang Zhao Shuo Wang Li Ma Yu Chen Xiaolin Chen Youxiang Li Yukun Zhang Tengfei Yu Heze Han |
| author_sort | Yang Zhao |
| collection | DOAJ |
| description | Objective Single-stage surgery combining embolisation and microsurgery has been increasingly used as a stand-alone procedure to cure complex AVMs. This study aimed to investigate the learning curve and embolisation strategy for single-stage surgery for AVMs.Methods This prospective cohort study used data from the nationwide Multimodality Treatment for Brain Arteriovenous Malformations (MATCH) registry in China, conducted between August 2011 and December 2023. A total of 213 complex AVMs were divided into two groups. Group 1 included the first 25 patients. The 188 cases in group 2 included patients numbered 26–213. A case-crossover design was employed to evaluate the influence of complications, unfavourable outcomes and worsening modified Rankin Scale (mRS) score. Cumulative summation analysis was performed to assess the learning curve.Results The rate of major complications decreased from 52.00% in group 1 to 34.57% in group 2 (p=0.089), while the rate of unfavourable outcomes decreased from 44.00% in group 1 to 18.62% in group 2 (p=0.004). The distribution of the three preoperative embolisation strategies was as follows: curative: 72.00% and 19.15%, palliative: 24.00% and 67.55%, and targeted: 4.00% and 13.30%, respectively (p<0.001). Multivariable regression analysis showed that surgeon experience was associated with a lower rate of unfavourable outcomes (p=0.022, OR=0.333). The mean follow-up duration was 49.90±20.54 months. The follow-up mRS score of 5–6 decreased from 9.09% in group 1 to 0.8% in group 2 (p=0.035).Conclusions Performing single-stage combined surgery in 25 AVM cases is necessary to achieve reproducibility. Rates of major complications and unfavourable outcomes decreased significantly after the first 50 procedures. Palliative and targeted embolisation strategies are associated with a lower rate of unfavourable outcomes.Trial registration number NCT04572568. |
| format | Article |
| id | doaj-art-d6f8f2a5f90c47cda7e06d9681fb60f0 |
| institution | DOAJ |
| issn | 2059-8696 |
| language | English |
| publisher | BMJ Publishing Group |
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| series | Stroke and Vascular Neurology |
| spelling | doaj-art-d6f8f2a5f90c47cda7e06d9681fb60f02025-08-20T03:17:01ZengBMJ Publishing GroupStroke and Vascular Neurology2059-869610.1136/svn-2025-004051Learning curve and embolisation strategy in single-stage surgery combined embolisation and microsurgery for brain arteriovenous malformations: results from a nationwide multicentre prospective registry studyYang Zhao0Shuo Wang1Li Ma2Yu Chen3Xiaolin Chen4Youxiang Li5Yukun Zhang6Tengfei Yu7Heze Han8Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, ChinaDepartment of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, ChinaDepartment of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, ChinaDepartment of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, ChinaDepartment of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, ChinaDepartment of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, ChinaDepartment of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, ChinaDepartment of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, ChinaDepartment of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, ChinaObjective Single-stage surgery combining embolisation and microsurgery has been increasingly used as a stand-alone procedure to cure complex AVMs. This study aimed to investigate the learning curve and embolisation strategy for single-stage surgery for AVMs.Methods This prospective cohort study used data from the nationwide Multimodality Treatment for Brain Arteriovenous Malformations (MATCH) registry in China, conducted between August 2011 and December 2023. A total of 213 complex AVMs were divided into two groups. Group 1 included the first 25 patients. The 188 cases in group 2 included patients numbered 26–213. A case-crossover design was employed to evaluate the influence of complications, unfavourable outcomes and worsening modified Rankin Scale (mRS) score. Cumulative summation analysis was performed to assess the learning curve.Results The rate of major complications decreased from 52.00% in group 1 to 34.57% in group 2 (p=0.089), while the rate of unfavourable outcomes decreased from 44.00% in group 1 to 18.62% in group 2 (p=0.004). The distribution of the three preoperative embolisation strategies was as follows: curative: 72.00% and 19.15%, palliative: 24.00% and 67.55%, and targeted: 4.00% and 13.30%, respectively (p<0.001). Multivariable regression analysis showed that surgeon experience was associated with a lower rate of unfavourable outcomes (p=0.022, OR=0.333). The mean follow-up duration was 49.90±20.54 months. The follow-up mRS score of 5–6 decreased from 9.09% in group 1 to 0.8% in group 2 (p=0.035).Conclusions Performing single-stage combined surgery in 25 AVM cases is necessary to achieve reproducibility. Rates of major complications and unfavourable outcomes decreased significantly after the first 50 procedures. Palliative and targeted embolisation strategies are associated with a lower rate of unfavourable outcomes.Trial registration number NCT04572568.https://svn.bmj.com/content/early/2025/04/07/svn-2025-004051.full |
| spellingShingle | Yang Zhao Shuo Wang Li Ma Yu Chen Xiaolin Chen Youxiang Li Yukun Zhang Tengfei Yu Heze Han Learning curve and embolisation strategy in single-stage surgery combined embolisation and microsurgery for brain arteriovenous malformations: results from a nationwide multicentre prospective registry study Stroke and Vascular Neurology |
| title | Learning curve and embolisation strategy in single-stage surgery combined embolisation and microsurgery for brain arteriovenous malformations: results from a nationwide multicentre prospective registry study |
| title_full | Learning curve and embolisation strategy in single-stage surgery combined embolisation and microsurgery for brain arteriovenous malformations: results from a nationwide multicentre prospective registry study |
| title_fullStr | Learning curve and embolisation strategy in single-stage surgery combined embolisation and microsurgery for brain arteriovenous malformations: results from a nationwide multicentre prospective registry study |
| title_full_unstemmed | Learning curve and embolisation strategy in single-stage surgery combined embolisation and microsurgery for brain arteriovenous malformations: results from a nationwide multicentre prospective registry study |
| title_short | Learning curve and embolisation strategy in single-stage surgery combined embolisation and microsurgery for brain arteriovenous malformations: results from a nationwide multicentre prospective registry study |
| title_sort | learning curve and embolisation strategy in single stage surgery combined embolisation and microsurgery for brain arteriovenous malformations results from a nationwide multicentre prospective registry study |
| url | https://svn.bmj.com/content/early/2025/04/07/svn-2025-004051.full |
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