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Microsurgical resection of Spetzler–Martin grades 1 and 2 unruptured brain arteriovenous malformations results in lower long-term morbidity and loss of quality-adjusted life-years (QALY) than conservative management—results of a single group series

  • Clinical Article - Vascular
  • Published:
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Abstract

Background

The therapeutic benefits of microsurgery for unruptured brain AVM remain unclear.

Methods

A series of 97 microsurgically resected unruptured brain AVM was analyzed in terms of postoperative morbidity and lifetime loss of quality-adjusted life-years (QALY). For comparison, the natural risk of becoming disabled was modeled on the basis of published data.

Results

Discharge morbidity was recorded in 11 of the 69 of Spetzler–Martin (SM) grade 1 and 2 AVMs (16 %), eight of 22 (36 %) grade 3, and four of six grade 4 (67 %), permanent morbidity >mRS 1 in 3 (4.3 %) grade 1 and 2, four (18 %) grade 3, and three (50 %) grade 4. Treatment inflicted loss of QALY amounted to 0.5 years for SM grade 1–2, 2.5 years grade 3, 7.3 years for grade 4. For the SM grades 1 and 2, the treatment-related loss of 0.5 QALY was met by the natural course after 2.7–4.3 years. For the Spetzler–Martin grades 3 and 4, the treatment-induced loss QALY was not met by the natural risk within a foreseeable time. Permanent morbidity and treatment inflicted loss of QALY of patients younger than 39 years was lower than that of older patients (7 vs. 15 % and 1.0 vs. 2.1 QALY).

Conclusions

Microsurgically managed SM grades 1 and 2 fared better than the modeled natural course but grades 3 and 4 AVM did not benefit from surgery. Younger patients appear to fare more favorably than older patients.

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Disclosure

All authors certify that they have no affiliations with or involvement in any organization or entity with any financial interest (such as honoraria; educational grants; participation in speakers’ bureaus; membership, employment, consultancies, stock ownership, or other equity interest; and expert testimony or patent-licensing arrangements), or non-financial interest (such as personal or professional relationships, affiliations, knowledge or beliefs) in the subject matter or materials discussed in this manuscript.

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Authors and Affiliations

  1. Department of Neurosurgery, Heinrich-Heine-Universität, Moorenstr. 5, Geb. 10.54, 40225, Düsseldorf, Germany

    Hans-Jakob Steiger, Benjamin Rohn, Nima Etminan & Daniel Hänggi

  2. Division of Informatics and Statistics, Department of Neurosurgery, Heinrich-Heine-Universität, Düsseldorf, Germany

    Igor Fischer

  3. Division of Neuroradiology, Institute of Radiology, Heinrich-Heine-Universität, Düsseldorf, Germany

    Bernd Turowski

Authors
  1. Hans-Jakob Steiger
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  2. Igor Fischer
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Correspondence to Hans-Jakob Steiger.

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Steiger, HJ., Fischer, I., Rohn, B. et al. Microsurgical resection of Spetzler–Martin grades 1 and 2 unruptured brain arteriovenous malformations results in lower long-term morbidity and loss of quality-adjusted life-years (QALY) than conservative management—results of a single group series. Acta Neurochir 157, 1279–1287 (2015). https://doi.org/10.1007/s00701-015-2474-9

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  • DOI: https://doi.org/10.1007/s00701-015-2474-9

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