Document Detail


Microsurgery or radiosurgery for cerebral arteriovenous malformations? A study of two paired series.
MedLine Citation:
PMID:  17621017     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
OBJECTIVE: To detect parameters that may augment the therapeutic strategy in patients with a cerebral arteriovenous malformation (AVM) that is considered equally suitable for treatment by neurosurgery or radiosurgery, we compared the efficacy and risks of these two methods in a paired series with similar patient and AVM characteristics. PATIENTS AND METHODS: Two series of patients with AVM were studied, including a series of 39 patients treated using microsurgery (MS) and another series of 39 patients treated via radiosurgery (RS). These series were paired for age and sex, initial symptoms, size, location and Spetzler-Martin grade, and presence of embolization preceding treatment. We compared the posttreatment outcome in the two groups with respect to obliteration rate, neurological status, mortality rate, and recurrent bleeding. Statistical analysis was performed using paired Student's t test. RESULTS: The Glasgow Outcome Scale values and Modified Rankin Scores measured at discharge and 12 to 24 months were significantly better in the RS series than in the MS series. The obliteration rate tended to be higher in the MS series (91% versus 81%; P = 0.10, not significant), whereas the rate of neurological deficit was higher in the MS series than in the RS series (P < 0.001). The mortality rate was not significantly different in the two series, but the rate of recurrent bleeding was higher in the RS group (10% versus 0%; P = 0.04). CONCLUSIONS: Although the rate of cure was similar for patients treated with MS and RS, neurological morbidity was higher after MS and recurrent bleeding was more frequent after RS.
Authors:
François Nataf; Michel Schlienger; Mohammed Bayram; May Ghossoub; Bernard George; François-Xavier Roux
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Publication Detail:
Type:  Comparative Study; Controlled Clinical Trial; Journal Article    
Journal Detail:
Title:  Neurosurgery     Volume:  61     ISSN:  1524-4040     ISO Abbreviation:  Neurosurgery     Publication Date:  2007 Jul 
Date Detail:
Created Date:  2007-07-10     Completed Date:  2007-08-07     Revised Date:  2009-04-16    
Medline Journal Info:
Nlm Unique ID:  7802914     Medline TA:  Neurosurgery     Country:  United States    
Other Details:
Languages:  eng     Pagination:  39-49; discussion 49-50     Citation Subset:  IM    
Affiliation:
Department of Neurosurgery, Sainte Anne Hospital, Paris, France. f.nataf@ch-sainte-anne.fr
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MeSH Terms
Descriptor/Qualifier:
Adult
Cerebral Revascularization / mortality*
Female
Humans
Intracranial Arteriovenous Malformations / mortality*,  surgery*
Male
Radiosurgery / mortality*
Risk Assessment / methods*
Risk Factors
Survival Analysis
Survival Rate
Treatment Outcome
Comments/Corrections
Comment In:
Neurosurgery. 2008 Aug;63(2):E376; author reply E376   [PMID:  18797326 ]

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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