International multi-center study to quantify the effect of deep venous drainage after surgical resection of Spetzler-Martin Grade II-III brain arteriovenous malformations
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.
Authors
- Assala Aslan (ORCID: https://orcid.org/0000-0001-8797-0808)
- Saman Sizdahkhani (ORCID: https://orcid.org/0000-0001-7066-2956)
- Hussein A. Zeineddine (ORCID: https://orcid.org/0000-0001-6144-8392)
- Hugo H Cuellar
- Rashad Jabarkheel (ORCID: https://orcid.org/0000-0002-7643-2622)
- Hamza Adel Salim (ORCID: https://orcid.org/0000-0002-5208-8425)
- John C. Dalfino (ORCID: https://orcid.org/0000-0001-9845-7284)
- Abdullah Keleş (ORCID: https://orcid.org/0000-0003-3604-9247)
- Deepak Kumbhare (ORCID: https://orcid.org/0000-0003-2514-9576)
- Najib Muhammad (ORCID: https://orcid.org/0000-0002-4031-8035)
- Edward R. Smith (ORCID: https://orcid.org/0000-0002-7434-5912)
- Bryan Pukenas
- Rajeev Sen (ORCID: https://orcid.org/0000-0002-9105-1668)
- Bharat Guthikonda (ORCID: https://orcid.org/0000-0001-6668-6656)
- Pierce Davis (ORCID: https://orcid.org/0009-0004-2411-9871)
- Ufuk Erginoğlu (ORCID: https://orcid.org/0000-0002-5387-4698)
- Matthew Koch
- Nathan Ramachandran
- C Stapleton
- Sandeep Muram (ORCID: https://orcid.org/0000-0002-0336-9511)
- A Paul
- Peng R. Chen (ORCID: https://orcid.org/0000-0002-0402-7417)
- A Abla
- Cagdas Ataoglu (ORCID: https://orcid.org/0009-0009-6566-6034)
- Daniel Sconzo (ORCID: https://orcid.org/0000-0001-8933-9083)
- Omar Alwakaa (ORCID: https://orcid.org/0009-0008-6441-5420)
- Sandeep Kandregula (ORCID: https://orcid.org/0000-0001-9392-3143)
- Sravanthi Koduri (ORCID: https://orcid.org/0000-0003-3645-4584)
- Hammam Abdalrazeq (ORCID: https://orcid.org/0009-0009-1885-5297)
- Abdallah Abushehab
- Christoph J. Griessenauer
- Alan S. Boulos (ORCID: https://orcid.org/0000-0003-4019-8368)
- Sanjeev Gummadi
- Natasha Ironside
- Omar Choudhri
- Amey Savardekar
- Pascal J. Mosimann
- Ali Alaraj
- Michael R. Levitt
- Laligam N. Sekhar
- Howard Riina
- Pascal Jabbour
- Michael Lawton
- Jan-Karl Burkhardt
- Christina Notarianni
- Robert M. Starke
- Adam A. Dmytriw
- Malia McAvoy
- Basel Musmar
- Ahmed Abdelsalam
- Jason Sheehan
- Visish M. Srinivasan
- Robert H. Rosenwasser
- Kareem El Naamani
- Nimer Adeeb
- Aman B. Patel
- Christopher S. Ogilvy
- Douglas Kondziolka
- Mohamed M. Salem
- Spiros Blackburn
- Jacques Morcos
- Joshua S. Catapano
- Johannes Pöppe
- David J. Altschul
- Mohammad A. Aziz-Sultan
- Darren Orbach
- Mustafa K. Baskaya
- Arwin Rezai
- Muhammed Amir Essibayi
- Salem M Tos
- Louis J. Kim
- Ketan Bulsara
- Neil Haranhalli
- Stavropoula I Tjoumakaris
- Avi A. Gajjar
- M. Reid Gooch
Institutions
- Brigham and Women's Hospital (US)
- Boston Children's Hospital (US)
- Albert Einstein College of Medicine (US)
- Beth Israel Deaconess Medical Center (US)
- Barrow Neurological Institute (US)
- Montefiore Medical Center (US)
- University of Wisconsin–Madison (US)
- Harvard University (US)
- University of Connecticut (US)
- University of Miami (US)
- University of Toronto (CA)
- University of Washington (US)
- Louisiana State University in Shreveport (US)
- Paracelsus Medical University (AT)
- Toronto Western Hospital (CA)
- Thomas Jefferson University Hospital (US)
- Hospital of the University of Pennsylvania (US)
- University of Florida (US)
- University of Illinois Chicago (US)
- Massachusetts General Hospital (US)
- Christian Doppler Klinik (AT)
- Mayo Clinic Hospital (US)
- University of Virginia (US)
- New York University (US)
- Albany Medical Center Hospital (US)
- Louisiana State University Health Sciences Center Shreveport (US)
- The University of Texas Health Science Center at Houston (US)
Publication Details
- Journal
- Neurosurgical Review
- Published
- 2026-05-22
- DOI
- https://doi.org/10.1007/s10143-026-04310-0
- Primary Topic
- Vascular Malformations Diagnosis and Treatment
- Type
- article
- Field-Weighted Citation Impact
- 0.00