Safety and efficacy of interventions for arteriouvenous malformations

January 01, 0001

Safety and efficacy of interventions for arteriouvenous malformations

Treatment of brain arteriovenous malformations (AVMs) include microsurgery, embolization, and stereotactic radiosurgery (SRS). These Dutch and Scottish researchers the outcomes of treating brain AVMs via a systematic review and meta-analysis. They searched PubMed and EMBASE supplemented by hand searching 6 journals, yielding 137 observational studies totaling 13 698 patients. Poisson regression analysis compared patient and study haracteristics to complications, long-term risk of hemorrhage, and treatment success.

The researchers found: "Case fatality was 0.68 per 100 person-years overall, 1.1 after microsurgery, 0.50 after SRS, and 0.96 after embolization. Intracranial hemorrhage rates were 1.4 per 100 person-years overall, 0.18 after microsurgery, 1.7 after SRS, and 1.7 after embolization. More recent studies were associated with lower case-fatality rates (rate ratio [RR

The researchers concluded: "Although case fatality after treatment has decreased over time, treatment of brain AVM remains associated with considerable risks and incomplete efficacy. Randomized controlled trials comparing different treatment modalities appear justified."

This systematic review and meta-analysis demonstrates treatment of AVMs still involves notable risk and there may be differences in efficacy between interventions.

For the full abstract, click here.

JAMA 306(18):2011-2019, 9 November 2011 © 2011 American Medical Association
Treatment of Brain Arteriovenous Malformations. Janneke van Beijnum, H. Bart van der Worp, Dennis R. Buis, et al. >

Category: K. Circulatory, N. Neurological. Keywords: arteriovenous malformations, brain, microsurgery, stereotactic radiosurgery, embolization, systematic review and meta-analysis, journal watch.
Synopsis edited by Dr Paul Schaefer, Toledo, Ohio. Posted on Global Family Doctor 2 December 2011

Pearls are an independent product of the Cochrane primary care group and are meant for educational use and not to guide clinical care.

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