Complication-Effectiveness Analysis for Brain Arteriovenous Malformation Surgery: A Prospective Cohort Study

Area of Science:

• Neurosurgery
• Interventional Neurology
• Medical Statistics

Background:

• Brain arteriovenous malformations (bAVMs) require safe and effective treatment interventions.
• Assessing treatment outcomes necessitates a method that integrates both complication rates and treatment efficacy.

Purpose of the Study:

• To introduce and apply complication-effectiveness analysis (CEA) for evaluating brain arteriovenous malformation (bAVM) treatments.
• To quantify the risk of neurological deficit associated with effectively treated bAVMs based on Spetzler-Ponce class (SPC).

Main Methods:

• Prospective database analysis of 779 patients undergoing 641 microsurgical resections.
• Calculation of surgical complication rates (modified Rankin Scale >1 at 12 months) per SPC.
• Kaplan-Meier analysis for long-term recurrence-free survival and integration into CEA.

Main Results:

• Surgical complication rates for SPC A, B, and C were 1.4%, 20%, and 41%, respectively.
• Nine-year freedom from recurrence was 97% for SPC A and 92% for other bAVMs.
• Nine-year CEA risk for SPC A, B, and C ranged from 1.4%, 22%-24%, and 45%-63%, respectively.

Conclusions:

• Complication-effectiveness analysis (CEA) provides a comprehensive measure of treatment outcomes for bAVMs.
• CEA integrates efficacy and safety, enabling better comparison of different treatment modalities.
• Risk stratification by Spetzler-Ponce class is crucial for understanding treatment outcomes in bAVM intervention.