Treatment Selection for Unruptured Small Cerebral Arteriovenous Malformations with Clinical Decision Analysis: Observation, Gamma Knife or Microsurgery?
| Autor: | Koichi Okiyama, Osamu Nagano, Machida Toshio, Nobuyuki Yasui, Inomori Shigeo, Toru Serizawa, Blood Vessels-Akita, Takashi Shuto, Nagano Osamu, Higuchi Yoshinori, Toshio Machida, Hideyo Fujino, Junichi Ono, Yasui Nobuyuki, Ono Junichi, Yoshinori Higuchi, Naokatsu Saeki, Shuto Takashi, Okiyama Koichi, Saeki Naokatsu, Serizawa Toru, Yamamoto Masaaki, Shigeo Inomori, Fujino Hideyo, Masaaki Yamamoto |
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| Rok vydání: | 2006 |
| Předmět: | |
| Zdroj: | Surgery for Cerebral Stroke. 34:152-156 |
| ISSN: | 1880-4683 0914-5508 |
| Popis: | We present an optimal treatment for unruptured small (3 cm or less) cerebral arteriovenous malformations (AVM) among conservative treatment, gamma knife surgery (GKS) and microsurgery using clinical decision analysis according to patients' age. All cases for this study were small AVMs. We analyzed 973 cases with conservative treatment, 176 with GKS and 110 with microsurgery. The expected utility indexes were calculated from the results of each group. We hypothesized the standardized expected utility indexes as 100 in healthy, 75 in disabled and 0 in dead. Microsurgery was the first choice for patients younger than 55 years with AVM located in a surgically accessible region. GKS is recommended for patients aged between 55 and 70, and the best treatment is observation for patients older than 70 years. The proposed clinical decision analysis is very useful in obtaining informed consent for choosing the treatment modality for unruptured small AVM. |
| Databáze: | OpenAIRE |
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