| Management of unruptured intracranial arteriovenous malformations: a decision analysis. | |
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MedLine Citation:
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PMID: 1584355 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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The management of unruptured intracranial arteriovenous malformations (AVMs) is controversial. Some authorities favor elective excision of the AVM before it bleeds, whereas others advise nonintervention unless the AVM bleeds, at which time surgical excision is performed in those who survive. A Markov model was developed that stimulates a clinical trial in which cohorts of patients with unruptured AVMs were assigned to either elective excision of their AVMs or conservative treatment (unless the AVM bled). Incremental utilities for both strategies were calculated at the end of each year after the beginning of the trial and are expressed as quality and risk-adjusted life years. The process was continued until all members of the cohorts had died. The mean quality and risk-adjusted life expectancy for members of a cohort was calculated by dividing the total number of quality and risk-adjusted life years the cohort had accumulated by the size of the cohort. If the baseline values for surgical complications were used in the computation, the quality and risk-adjusted life expectancy for the surgical cohorts was at least 1 quality and risk-adjusted life year greater than for nonsurgical cohorts up to age 44. If a more favorable complication rate were used, elective surgery could benefit selected patients in their early 60s when the location and configuration of the AVM was favorable. Elective surgical resection is justified in many instances before rupture, particularly in young patients who have intracranial AVMs that have a favorable location, size, and venous drainage. |
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Authors:
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R G Auger; D O Wiebers |
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Publication Detail:
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Type: Journal Article |
Journal Detail:
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Title: Neurosurgery Volume: 30 ISSN: 0148-396X ISO Abbreviation: Neurosurgery Publication Date: 1992 Apr |
Date Detail:
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Created Date: 1992-06-16 Completed Date: 1992-06-16 Revised Date: 2004-11-17 |
Medline Journal Info:
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Nlm Unique ID: 7802914 Medline TA: Neurosurgery Country: UNITED STATES |
Other Details:
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Languages: eng Pagination: 561-9 Citation Subset: IM |
Affiliation:
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Department of Neurology, Mayo Clinic, Rochester, Minnesota. |
Export Citation:
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APA/MLA Format Download EndNote Download BibTex |
| MeSH Terms | |
Descriptor/Qualifier:
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Cerebral Hemorrhage
/
etiology,
prevention & control Cohort Studies Computer Simulation* Decision Making, Computer-Assisted Decision Support Techniques* Decision Trees Humans Intracranial Arteriovenous Malformations / complications, surgery, therapy* Markov Chains Models, Biological Postoperative Complications Risk Rupture, Spontaneous |
| Comments/Corrections | |
Comment In:
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Neurosurgery. 1993 Jul;33(1):172-3
[PMID:
8355842
]
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From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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