The effect of incomplete patient follow-up on the reported results of AVM radiosurgery. Surg Neurol 1998 Apr;49(4):373-81; discussion 381-4
Date
04/16/1998Pubmed ID
9537655DOI
10.1016/s0090-3019(97)00441-2Scopus ID
2-s2.0-0032053862 (requires institutional sign-in at Scopus site) 33 CitationsAbstract
BACKGROUND: The reported efficacy of AVM radiosurgery--80-85% 2-year obliteration rate--is based exclusively on the results of follow-up arteriography in a small percentage of treated patients; it is therefore inaccurate. We examined the effect of incomplete follow-up on the results of AVM radiosurgery.
METHODS: We reviewed the results of AVM radiosurgery in 82 patients after a minimum of 24 months of follow-up. Patients were not preselected to undergo arteriography on the basis of any other imaging study. Data were analyzed using the Kaplan-Meier method and stratified by size of AVM. Results were compared with those obtained from the same data using the reporting techniques described in the literature.
RESULTS: When data analysis was limited to patients who had follow-up arteriography, the 2-, 3-, and 4-year obliteration rates were 37%, 73%, and 84% after a minimum 24-month follow-up. Using Kaplan-Meier analysis the 2-, 3-, and 4-year obliteration rates were 32%, 55%, and 55% (95% CI = +/-18%), respectively. The 2-year obliteration rate was 43% for AVMs <30 mm in diameter and 16% for AVMs >30 mm in diameter, respectively.
CONCLUSION: If data analysis is limited to the patients who undergo follow-up arteriography, the obliteration rate of AVM radiosurgery is overestimated. The actual 2-year obliteration rate if all data is considered is in the range of 40% rather than the commonly reported 80%. Therefore, treated patients are exposed to the risk of intracerebral hemorrhage for a longer period than previously appreciated. Compulsive long-term follow-up is required to document the true AVM obliteration rate after treatment by radiosurgery.
Author List
Heffez DS, Osterdock RJ, Alderete L, Grutsch JAuthor
Dan S. Heffez MD Professor in the Neurosurgery department at Medical College of WisconsinMESH terms used to index this publication - Major topics in bold
AlgorithmsCerebral Angiography
Follow-Up Studies
Humans
Intracranial Arteriovenous Malformations
Life Tables
Radiosurgery
Treatment Outcome