Complication-effectiveness analyses increase the information available with regard to outcome for the management of Unruptured Intracranial Aneurysm Surgery 1).
Intervention for brain arteriovenous malformations (bAVMs) should aim at treatment that is safe and effective.
First, Morgan et al calculated the percentage of surgical complications leading to a modified Rankin Scale >1 at 12 months after surgery for each Spetzler Ponce classification class (SPC). Second, they performed a sensitivity analysis of these results by including bAVMs not undergoing surgery, to correct for bias. Third, they established the long-term cumulative incidence of freedom from recurrence from Kaplan Meier analysis. Finally, they combined the results to calculate the risk of surgery per effective treatment in a complication-effectiveness analysis.
Seven hundred seventy-nine patients underwent 641 microsurgical resections. Complications of surgery leading to a modified Rankin Scale >1 at 12 months occurred in 1.4% (95% confidence interval [CI]: 0.5-3.3), 20% (95% CI: 15-26), and 41% (95% CI: 30-52) of SPC A, SPC B, and SPC C, respectively. The cumulative 9-year freedom from recurrence was 97% for SPC A and 92% for other bAVMs. The 9-year CEA risk was 1.4% (credible range: 0.5%-3.4%) for SPC A, 22% to 24% (credible range: 16%-31%) for SPC B, and 45% to 63% (credible range: 33%-73%) for SPC C bAVM.
CEA presents the treatment outcome in the context of efficacy and provides a basis for comparing outcomes from techniques with different times to elimination of the bAVM 2).