• Tamer Hassan, Mohamed Refaat, Alaa Mohamed Issa, Ahmed Sultan, and Tamer Ibrahim.
• Department of Neurosurgery, Alexandria University School of Medicine, Alexandria, Egypt. Electronic address: tamer.shihata@alexmed.edu.eg.
• World Neurosurg. 2023 Dec 1; 180: e749e755e749-e755.

BackgroundGrade III brain arteriovenous malformation (AVM) is a distinct subgroup of AVMs that encompasses multiple subtypes according to the Spetzler-Martin classification.MethodsThis retrospective study included 61 patients with grade III AVM who underwent embolization between 2010 and 2022. The study analyzed the angioarchitecture of the AVM nidus and evaluated the outcomes of the embolization procedures.ResultsThere were 29 patients (47.5%) with subtype S1E1V1, 20 patients (32.8%) with subtype S2E1V0, and 12 patients (19.7%) with subtype S2E0V1. The rate of complete occlusion in all patients was 47.5% (29 patients). The rate of complete occlusion was higher in cases with a compact nidus (P < 0.001). Several parameters were associated with occlusion of the AVM nidus, including ≤3 arterial feeders (P = 0.017) and presentation with hemorrhage (P = 0.007), with the majority of patients with a compact nidus presenting with hemorrhage. Other factors associated with compact geometry were the presence of a single deep vein, ≤3 arterial feeders, ≤2 superficial draining veins, and an AVM nidus size ≤3 cm.ConclusionsThe compact nature of grade III AVM is a crucial predictor for the success of embolization. Several characteristics associated with a compact nidus, such as presentation with hemorrhage and a lower number of arterial feeders, have a significantly higher closure rate. Other factors, such as a single deep draining vein, reduced superficial venous drainage, and small size, show a strong association with complete obliteration.Copyright © 2023 Elsevier Inc. All rights reserved.

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