Natural History and Outcomes of Deep-seated Brain Arteriovenous Malformations: a Propensity Score Matched Analysis Using Nationwide Multicenter Prospective Registry Data

Objectives: This study aims to evaluate the natural history of deep-seated brain arteriovenous malformation (AVMs), as well as the risk-benefit outcomes of interventional treatment versus conservative management. Materials HR: 4.862 1.869-12.651, P<0.001) and higher obliteration rates (OR: 108.56 14.57–809.01, P<0.001). No significant differences were observed in terms of neurological functional outcomes. In a further analysis stratified by interventional strategies, embolization and multimodality treatment significantly increased the risk of hemorrhagic stroke or death compared with conservative treatment (embolization: HR: 4.414 95%CI, 1.642-11.867; multimodality treatment: HR, 6.238 95%CI, 2.146-18.136), while microsurgical resection and stereotactic radiosurgery did not. Subgroup and sensitivity analyses showed consistent trends, though with slight differences in statistical power. Conclusion: This study indicates that in deep-seated AVMs, interventional treatment is associated with an increased risk of hemorrhagic stroke or death. However, the negative effect may result from the adverse effects of embolization and multimodality treatment, whereas microsurgical resection and stereotactic radiosurgery did not.