title: Microsurgery or radiosurgery for cerebral arteriovenous malformations? A study of two paired series.
abstract: OBJECTIVE
  To detect parameters that may augment the therapeutic strategy in patients with a cerebral arteriovenous malformation (AVM) that is considered equally suitable for treatment by neurosurgery or radiosurgery, we compared the efficacy and risks of these two methods in a paired series with similar patient and AVM characteristics.
  
  
  METHODS
  Two series of patients with AVM were studied, including a series of 39 patients treated using microsurgery (MS) and another series of 39 patients treated via radiosurgery (RS). These series were paired for age and sex, initial symptoms, size, location and Spetzler-Martin grade, and presence of embolization preceding treatment. We compared the posttreatment outcome in the two groups with respect to obliteration rate, neurological status, mortality rate, and recurrent bleeding. Statistical analysis was performed using paired Student's t test.
  
  
  RESULTS
  The Glasgow Outcome Scale values and Modified Rankin Scores measured at discharge and 12 to 24 months were significantly better in the RS series than in the MS series. The obliteration rate tended to be higher in the MS series (91% versus 81%; P = 0.10, not significant), whereas the rate of neurological deficit was higher in the MS series than in the RS series (P < 0.001). The mortality rate was not significantly different in the two series, but the rate of recurrent bleeding was higher in the RS group (10% versus 0%; P = 0.04).
  
  
  CONCLUSIONS
  Although the rate of cure was similar for patients treated with MS and RS, neurological morbidity was higher after MS and recurrent bleeding was more frequent after RS.
authors.affiliation: Department of Neurosurgery, Sainte Anne Hospital, Paris, France. f.nataf@ch-sainte-anne.fr
authors.forename: François
authors.initials: F
authors.lastname: Nataf
authors.forename: Michel
authors.initials: M
authors.lastname: Schlienger
authors.forename: Mohammed
authors.initials: M
authors.lastname: Bayram
authors.forename: May
authors.initials: M
authors.lastname: Ghossoub
authors.forename: Bernard
authors.initials: B
authors.lastname: George
authors.forename: François-Xavier
authors.initials: FX
authors.lastname: Roux
mesh_terms: D000328:Adult; D002548:Cerebral Revascularization / Q000401:mortality*; D005260:Female; D006801:Humans; D002538:Intracranial Arteriovenous Malformations / Q000401:mortality* / Q000601:surgery*; D008297:Male; D016634:Radiosurgery / Q000401:mortality*; D018570:Risk Assessment / Q000379:methods*; D012307:Risk Factors; D016019:Survival Analysis; D015996:Survival Rate; D016896:Treatment Outcome