caa a22 4500 606216030 CHVBK 20210128101101.0 cr unu---uuuuu 210128e20150801xx s 000 0 eng 10.1007/s00701-015-2474-9 doi (NATIONALLICENCE)springer-10.1007/s00701-015-2474-9 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 [Elektronische Daten] [Hans-Jakob Steiger, Igor Fischer, Benjamin Rohn, Bernd Turowski, Nima Etminan, Daniel Hänggi] 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 0.5years for SM grade 1-2, 2.5years grade 3, 7.3years 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 2.7-4.3years. 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 39years 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. Springer-Verlag Wien, 2015 Unruptured brain arteriovenous malformation nationallicence Microsurgery nationallicence Morbidity nationallicence Quality of life nationallicence Steiger Hans-Jakob Department of Neurosurgery, Heinrich-Heine-Universität, Moorenstr. 5, Geb. 10.54, 40225, Düsseldorf, Germany aut Fischer Igor Division of Informatics and Statistics, Department of Neurosurgery, Heinrich-Heine-Universität, Düsseldorf, Germany aut Rohn Benjamin Department of Neurosurgery, Heinrich-Heine-Universität, Moorenstr. 5, Geb. 10.54, 40225, Düsseldorf, Germany aut Turowski Bernd Division of Neuroradiology, Institute of Radiology, Heinrich-Heine-Universität, Düsseldorf, Germany aut Etminan Nima Department of Neurosurgery, Heinrich-Heine-Universität, Moorenstr. 5, Geb. 10.54, 40225, Düsseldorf, Germany aut Hänggi Daniel Department of Neurosurgery, Heinrich-Heine-Universität, Moorenstr. 5, Geb. 10.54, 40225, Düsseldorf, Germany aut Acta Neurochirurgica Springer Vienna 157/8(2015-08-01), 1279-1287 0001-6268 157:8<1279 2015 157 701 https://doi.org/10.1007/s00701-015-2474-9 text/html Onlinezugriff via DOI BK010053 XK010053 XK010000 Metadata rights reserved Springer special CC-BY-NC licence nationallicence 1 research-article jats NATIONALLICENCE NATIONALLICENCE NL-springer NATIONALLICENCE 856 40 https://doi.org/10.1007/s00701-015-2474-9 text/html Onlinezugriff via DOI NATIONALLICENCE 700 1- Steiger Hans-Jakob Department of Neurosurgery, Heinrich-Heine-Universität, Moorenstr. 5, Geb. 10.54, 40225, Düsseldorf, Germany aut NATIONALLICENCE 700 1- Fischer Igor Division of Informatics and Statistics, Department of Neurosurgery, Heinrich-Heine-Universität, Düsseldorf, Germany aut NATIONALLICENCE 700 1- Rohn Benjamin Department of Neurosurgery, Heinrich-Heine-Universität, Moorenstr. 5, Geb. 10.54, 40225, Düsseldorf, Germany aut NATIONALLICENCE 700 1- Turowski Bernd Division of Neuroradiology, Institute of Radiology, Heinrich-Heine-Universität, Düsseldorf, Germany aut NATIONALLICENCE 700 1- Etminan Nima Department of Neurosurgery, Heinrich-Heine-Universität, Moorenstr. 5, Geb. 10.54, 40225, Düsseldorf, Germany aut NATIONALLICENCE 700 1- Hänggi Daniel Department of Neurosurgery, Heinrich-Heine-Universität, Moorenstr. 5, Geb. 10.54, 40225, Düsseldorf, Germany aut NATIONALLICENCE 773 0- Acta Neurochirurgica Springer Vienna 157/8(2015-08-01), 1279-1287 0001-6268 157:8<1279 2015 157 701