Learning curve and embolisation strategy in single-stage surgery combined embolisation and microsurgery for brain arteriovenous malformations - Abstract

Q: What is the objective of the study on AVMs?

To investigate the learning curve and embolisation strategy for single-stage surgery that combines embolisation and microsurgery in complex AVMs.

Q: How was the study conducted and how were patients grouped?

A nationwide prospective cohort study used MATCH registry data from 2011–2023 and included 213 complex AVMs divided into group 1 (first 25 patients) and group 2 (patients 26–213).

Q: What major outcome changes were observed across groups?

Major complications and unfavourable outcomes decreased from group 1 to group 2, and follow-up mRS 5–6 proportions were lower in group 2.

Sep 29, 2026

Uploaded by ahduag

Single-stage surgery combining embolisation and microsurgery is increasingly used as a standalone cure for complex brain arteriovenous malformations (AVMs). This prospective cohort study uses nationwide MATCH registry data from August 2011 to December 2023, including 213 complex AVMs evaluated across two groups (patients 1–25 vs 26–213). Results show declining major complications and unfavourable outcomes, with surgeon experience and embolisation strategy linked to outcomes.

LanguageEnglish

CategoryHealthcare

FormatPDF

Pages11

Reading Time28 min

AccessFree to download

Abstract

Objective

Methods

Results

Conclusions

Introduction

What is already known on this topic

What this study adds

How this study might affect research, practice or policy

Open access Original research 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 Tengfei Yu,1 Heze Han ,1 Li Ma,1,2 Yang Zhao ,1,3 Yukun Zhang,1,3 Youxiang Li,1 Shuo Wang ,1 Yu Chen ,1 Xiaolin Chen1 To cite: Yu T, Han H, Ma L, et al. 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 & Vascular Neurology 2025;0 . doi:10 . 1136/ svn-2025-004051 ► Additional supplemental material is published online only. To view, please visit the journal online ([https://doi.org/10.1136/](https://doi.org/10.1136/)[ ](https://doi.org/10.1136/)[svn-2025-004051](svn-2025-004051)) . Received 15 January 2025 Accepted 25 March 2025 © Author(s) (or their employer(s)) 2025. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ Group. 1Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China 2Department of Neurological Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA 3Department of Neurosurgery, Peking University International Hospital, Beijing, China Correspondence to Yu Chen; [chenyu_tiantan@126.com](chenyu_tiantan@126.com) Xiaolin Chen; [xiaolinchen488@hotmail.com](xiaolinchen488@hotmail.com) ABSTRACT Objective Single-stage surgery combining embolisation and microsurgery has been increasingly used as a standalone 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 casecrossover 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. INTRODUCTION Arteriovenous malformations (AVMs) are complex and rare cerebral vascular dysplasias characterised by a dense tangle of abnormally WHAT IS ALREADY KNOWN ON THIS TOPIC | ⇒ Several studies have proposed that a single-stage combined embolisation and microsurgery strategy might benefit the long-term neurofunctional outcomes of complex arteriovenous malformations (AVMs) . Although previous studies have shown an association between operator experience and patient outco

FAQs

What is the objective of the study on AVMs?

To investigate the learning curve and embolisation strategy for single-stage surgery that combines embolisation and microsurgery in complex AVMs.

How was the study conducted and how were patients grouped?

A nationwide prospective cohort study used MATCH registry data from 2011–2023 and included 213 complex AVMs divided into group 1 (first 25 patients) and group 2 (patients 26–213).

What major outcome changes were observed across groups?

Major complications and unfavourable outcomes decreased from group 1 to group 2, and follow-up mRS 5–6 proportions were lower in group 2.

Sep 29, 2026

Uploaded by ahduag