{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,3]],"date-time":"2026-10-03T17:20:24Z","timestamp":1791048024644,"version":"4.1.0"},"reference-count":40,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"12","license":[{"start":{"date-parts":[[2023,9,14]],"date-time":"2023-09-14T00:00:00Z","timestamp":1694649600000},"content-version":"unspecified","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/ http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["lww.com","ovid.com"],"crossmark-restriction":true},"short-container-title":[],"abstract":"<jats:sec>\n            <jats:title>Background:<\/jats:title>\n            <jats:p>This study aimed to compare the risk and benefit profile of microsurgery (MS) and stereotactic radiosurgery (SRS) as the first-line treatment for unruptured and ruptured arteriovenous malformations (AVMs).<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Materials and Methods:<\/jats:title>\n            <jats:p>The authors included AVMs underwent MS or SRS as the first-line treatment from a nationwide prospective multicenter registry in mainland China. The authors used propensity score-matched methods to balance baseline characteristics between the MS and SRS groups. The primary outcomes were long-term hemorrhagic stroke or death, and the secondary outcomes were long-term obliteration and neurological outcomes. Subgroup analyses and sensitivity analyses with different study designs were performed to confirm the stability of our findings.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Results:<\/jats:title>\n            <jats:p>Of the 4286 consecutive AVMs in the registry from August 2011 to December 2021; 1604 patients were eligible. After matching, 244 unruptured and 442 ruptured AVMs remained for the final analysis. The mean follow-up duration was 7.0 years in the unruptured group and 6.1 years in the ruptured group. In the comparison of primary outcomes, SRS was associated with a higher risk of hemorrhagic stroke or death both in the unruptured and ruptured AVMs (unruptured: hazard ratio 4.06, 95% CI: 1.15\u201314.41; ruptured: hazard ratio 4.19, 95% CI: 1.58\u201311.15). In terms of the secondary outcomes, SRS was also observed to have a significant disadvantage in long-term obliteration [unruptured: odds ratio (OR) 0.01, 95% CI: 0.00\u20130.04; ruptured: OR 0.09, 95% CI: 0.05\u20130.15]. However, it should be noted that SRS may have advantages in preventing neurofunctional decline (unruptured: OR 0.56, 95% CI: 0.27\u20131.14; ruptured: OR 0.41, 95% CI: 0.23\u20130.76). The results of subgroup analyses and sensitivity analyses were consistent in trend but with slightly varied powers.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Conclusions:<\/jats:title>\n            <jats:p>This clinical practice-based real-world study comprehensively compared MS and SRS for AVMs with long-term outcomes. MS is more effective in preventing future hemorrhage or death and achieving obliteration, while the risk of neurofunctional decline should not be ignored.<\/jats:p>\n          <\/jats:sec>","DOI":"10.1097\/js9.0000000000000751","type":"journal-article","created":{"date-parts":[[2023,9,18]],"date-time":"2023-09-18T05:14:05Z","timestamp":1695014045000},"page":"3983-3992","update-policy":"https:\/\/doi.org\/10.1097\/lww.0000000000001000","source":"Crossref","is-referenced-by-count":6,"title":["Long-term outcomes of microsurgery and stereotactic radiosurgery as the first-line treatment for arteriovenous malformations: a propensity score-matched analysis using nationwide multicenter prospective registry data"],"prefix":"10.1097","volume":"109","author":[{"given":"Heze","family":"Han","sequence":"first","affiliation":[{"name":"Department of Neurosurgery"},{"name":"China National Clinical Research Center for Neurological Diseases, Beijing"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dezhi","family":"Gao","sequence":"additional","affiliation":[{"name":"Department of Gamma-Knife Center"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Li","family":"Ma","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery"},{"name":"China National Clinical Research Center for Neurological Diseases, Beijing"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ruinan","family":"Li","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery"},{"name":"China National Clinical Research Center for Neurological Diseases, Beijing"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zhipeng","family":"Li","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery"},{"name":"China National Clinical Research Center for Neurological Diseases, Beijing"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Haibin","family":"Zhang","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery"},{"name":"China National Clinical Research Center for Neurological Diseases, Beijing"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kexin","family":"Yuan","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery"},{"name":"China National Clinical Research Center for Neurological Diseases, Beijing"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ke","family":"Wang","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery"},{"name":"China National Clinical Research Center for Neurological Diseases, Beijing"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yukun","family":"Zhang","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Peking University International Hospital, Peking 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Shijiazhuang"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Debin","family":"Yan","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Shanxi Provincial People\u2019s Hospital, Shanxi"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Runting","family":"Li","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery"},{"name":"China National Clinical Research Center for Neurological Diseases, Beijing"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Fa","family":"Lin","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery"},{"name":"China National Clinical Research Center for Neurological Diseases, Beijing"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Qiang","family":"Hao","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery"},{"name":"China National Clinical Research Center for Neurological Diseases, Beijing"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hao","family":"Wang","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery"},{"name":"China National Clinical Research Center for Neurological Diseases, Beijing"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xun","family":"Ye","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery"},{"name":"China National Clinical Research Center for Neurological Diseases, Beijing"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shuai","family":"Kang","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery"},{"name":"China National Clinical Research Center for Neurological Diseases, Beijing"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jun","family":"Pu","sequence":"additional","affiliation":[{"name":"First Department of Neurosurgery, The Second Affiliated Hospital of Kunming Medical University, Kunming"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zhiyong","family":"Shi","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Nanjing Drum Tower Hospital, Affiliated to Nanjing University, Nanjing, Jiangsu"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xiaofeng","family":"Chao","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, The Second Affiliated Hospital of Xuzhou Medical University, Jiangsu"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zhengfeng","family":"Lin","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, The First People\u2019s Hospital of Qinzhou, Guangxi"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Junlin","family":"Lu","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, West China Hospital, Sichuan University, Chengdu, Sichuan, People\u2019s Republic of 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