Choice of Treatment for Cerebral Arteriovenous Malformations: A Clinical Decision Analysis

To decide optimal treatment for various cerebral arteriovenous malformations (AVMs) is a highly complex issue. We retrospectively examined the clinical course of 24 cases of AVMs in reference to angiographic features, and performed clinical decision analysis to develop a logical therapeutic strategy. Annual bleeding rate was calculated in each group with specific angioarchitecture. The average bleeding rate was estimated at 3.2% per year. The rate was higher in the group with more hazardous angioarchitectures: 8.6% with intranidal aneurysm, and 5.5% with venous stenosis, respectively. Decision analysis demonstrated that Spetzler grade III AVM patients of 56 years or younger can expect better results from surgery than from conservative treatment. In grade IV, those of 48 years or younger can also expect better results from surgery. Because bleeding tends to develop more frequently in patients with intranidal aneurysm, older patients with this angioarchitecture (grade III: up to 70 years, grade IV: up to 60 years) can still expect better results from surgery. Clinical decision analysis is a helpful approach to plan a logical therapeutic strategy for AVMs.