{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,11,6]],"date-time":"2026-11-06T20:57:29Z","timestamp":1793998649633,"version":"4.8.0"},"reference-count":27,"publisher":"Journal of Neurosurgery Publishing Group (JNSPG)","issue":"1","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2024,1,1]]},"abstract":"<jats:sec>\n<jats:title>OBJECTIVE<\/jats:title>\n<jats:p>The optimal microsurgical timing in ruptured brain arteriovenous malformations (AVMs) is not well understood and is surrounded by controversy. This study aimed to elucidate the impacts of microsurgical resection timing on clinical outcomes.<\/jats:p>\n<\/jats:sec>\n<jats:sec>\n<jats:title>METHODS<\/jats:title>\n<jats:p>The authors retrieved and reviewed the records on all ruptured AVMs treated at their institution and registered in a nationwide multicenter prospective collaboration registry between August 2011 and August 2021. Patients were dichotomized into an early resection group (\u2264 30 days from the last hemorrhagic stroke) and a delayed resection group (&gt; 30 days after the last hemorrhagic stroke). Propensity score\u2013matched analysis was used to compare long-term outcomes. The primary outcome was neurological status as assessed using the modified Rankin Scale (mRS). The secondary outcomes were complete obliteration rate, postoperative seizure, and postoperative hemorrhage.<\/jats:p>\n<\/jats:sec>\n<jats:sec>\n<jats:title>RESULTS<\/jats:title>\n<jats:p>Of the 3649 consecutive AVMs treated at the authors\u2019 institution, a total of 558 ruptured AVMs were microsurgically resected and had long-term follow-up. After propensity score matching, 390 ruptured AVMs (195 pairs) were included in the comparison of outcomes. The mean (\u00b1 standard deviation) clinical follow-up duration was 4.93 \u00b1 2.94 years in the early resection group and 5.61 \u00b1 2.56 years in the delayed resection group. Finally, as regards the distribution of mRS scores, short-term neurological outcomes were better in the delayed resection group (risk difference [RD] 0.3%, 95% CI \u22120.1% to 0.6%, p = 0.010), whereas long-term neurological outcomes were similar between the two groups (RD 0.0%, 95% CI \u22120.2% to 0.2%, p = 0.906). Long-term favorable neurological outcomes (early vs delayed: 90.8% vs 90.3%, p &gt; 0.999; RD 0.5%, 95% CI \u22125.8% to 6.9%; RR 1.01, 95% CI 0.94\u20131.07) and long-term disability (9.2% vs 9.7%, p &gt; 0.999; RD \u22120.5%, 95% CI \u22126.9% to 5.8%; RR 0.95, 95% CI 0.51\u20131.75) were also similar between these groups. In terms of secondary outcomes, postoperative seizure (early vs delayed: 8.7% vs 5.6%, p = 0.239; RD 3.1%, 95% CI \u22122.6% to 8.8%; RR 1.55, 95% CI 0.74\u20133.22), postoperative hemorrhage (1.0% vs 1.0%, p &gt; 0.999; RD 0.0%, 95% CI \u22123.1% to 3.1%; RR 1.00, 95% CI 0.14\u20137.04), and hospitalization time (16.4 \u00b1 8.5 vs 19.1 \u00b1 7.9 days, p = 0.793) were similar between the two groups, whereas early resection had a lower complete obliteration rate (91.3% vs 99.0%, p = 0.001; RD \u22127.7%, 95% CI \u221212.9% to 3.1%; RR 0.92, 95% CI 0.88\u20130.97).<\/jats:p>\n<\/jats:sec>\n<jats:sec>\n<jats:title>CONCLUSIONS<\/jats:title>\n<jats:p>Early and delayed resection of ruptured AVMs had similar long-term neurological outcomes. Delayed resection can lead to a higher complete obliteration rate, although the risk of rerupture during the resection waiting period should be vigilantly monitored.<\/jats:p>\n<\/jats:sec>","DOI":"10.3171\/2023.5.jns222666","type":"journal-article","created":{"date-parts":[[2023,7,8]],"date-time":"2023-07-08T15:05:48Z","timestamp":1688828748000},"page":"164-171","source":"Crossref","is-referenced-by-count":19,"title":["Timing of microsurgical resection for ruptured brain arteriovenous malformations: a propensity score\u2013matched analysis using prospective single-center registry data"],"prefix":"10.3171","volume":"140","author":[{"given":"Yukun","family":"Zhang","sequence":"first","affiliation":[{"name":"Departments of Neurosurgery and"},{"name":"China National Clinical Research Center for Neurological Diseases, Beijing;"},{"name":"Department of Neurosurgery, Peking University International Hospital, Beijing;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yu","family":"Chen","sequence":"additional","affiliation":[{"name":"Departments of Neurosurgery and"},{"name":"China National Clinical Research Center for Neurological Diseases, Beijing;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Heze","family":"Han","sequence":"additional","affiliation":[{"name":"Departments of Neurosurgery and"},{"name":"China National Clinical Research Center for Neurological Diseases, Beijing;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Li","family":"Ma","sequence":"additional","affiliation":[{"name":"Departments of Neurosurgery and"},{"name":"China National Clinical Research Center for Neurological Diseases, Beijing;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ruinan","family":"Li","sequence":"additional","affiliation":[{"name":"Departments of Neurosurgery and"},{"name":"China National Clinical Research Center for Neurological Diseases, Beijing;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zhipeng","family":"Li","sequence":"additional","affiliation":[{"name":"Departments of Neurosurgery and"},{"name":"China National Clinical Research Center for Neurological Diseases, Beijing;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Debin","family":"Yan","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Shanxi Provincial People\u2019s Hospital, Taiyuan, Shanxi;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Haibin","family":"Zhang","sequence":"additional","affiliation":[{"name":"Departments of Neurosurgery and"},{"name":"China National Clinical Research Center for Neurological Diseases, Beijing;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kexin","family":"Yuan","sequence":"additional","affiliation":[{"name":"Departments of Neurosurgery and"},{"name":"China National Clinical Research Center for Neurological Diseases, Beijing;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ke","family":"Wang","sequence":"additional","affiliation":[{"name":"Departments of Neurosurgery and"},{"name":"China National Clinical Research Center for Neurological Diseases, Beijing;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yang","family":"Zhao","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Peking University International Hospital, Beijing;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Weitao","family":"Jin","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Peking University International Hospital, Beijing;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hengwei","family":"Jin","sequence":"additional","affiliation":[{"name":"Interventional Neuroradiology, Beijing Tiantan Hospital, Capital Medical University, Beijing;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xiangyu","family":"Meng","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, The First Hospital of Hebei Medical University, Hebei Medical University, Shijiazhuang, Hebei; and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Runting","family":"Li","sequence":"additional","affiliation":[{"name":"Departments of Neurosurgery and"},{"name":"China National Clinical Research Center for Neurological Diseases, Beijing;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Fa","family":"Lin","sequence":"additional","affiliation":[{"name":"Departments of Neurosurgery and"},{"name":"China National Clinical Research Center for Neurological Diseases, Beijing;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Qiang","family":"Hao","sequence":"additional","affiliation":[{"name":"Departments of Neurosurgery and"},{"name":"China National Clinical Research Center for Neurological Diseases, Beijing;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hao","family":"Wang","sequence":"additional","affiliation":[{"name":"Departments of Neurosurgery and"},{"name":"China National Clinical Research Center for Neurological Diseases, Beijing;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xun","family":"Ye","sequence":"additional","affiliation":[{"name":"Departments of Neurosurgery and"},{"name":"China National Clinical Research Center for Neurological Diseases, Beijing;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shuai","family":"Kang","sequence":"additional","affiliation":[{"name":"Departments of Neurosurgery and"},{"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, Beijing Tiantan Hospital, Capital Medical University, Beijing, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shibin","family":"Sun","sequence":"additional","affiliation":[{"name":"Department of Gamma-Knife Center, Beijing Tiantan Hospital, Capital Medical University, Beijing, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ali","family":"Liu","sequence":"additional","affiliation":[{"name":"Department of Gamma-Knife Center, Beijing Tiantan Hospital, Capital Medical University, Beijing, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Youxiang","family":"Li","sequence":"additional","affiliation":[{"name":"Interventional Neuroradiology, Beijing Tiantan Hospital, Capital Medical University, Beijing;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xiaolin","family":"Chen","sequence":"additional","affiliation":[{"name":"Departments of Neurosurgery and"},{"name":"China National Clinical Research Center for Neurological Diseases, Beijing;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shuo","family":"Wang","sequence":"additional","affiliation":[{"name":"Departments of Neurosurgery and"},{"name":"China National Clinical Research Center for Neurological Diseases, Beijing;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yuanli","family":"Zhao","sequence":"additional","affiliation":[{"name":"Departments of Neurosurgery and"},{"name":"China National Clinical Research Center for Neurological Diseases, Beijing;"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1754","reference":[{"issue":"20","key":"b1","series-title":"Neurology","first-page":"917","article-title":"Brain arteriovenous malformations: a review of natural history, pathobiology, and interventions","volume":"95","author":"Chen CJ","year":"2020","unstructured":"Chen CJ, Ding D, Derdeyn CP,  Brain arteriovenous malformations: a review of natural history, pathobiology, and interventions. 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