EBS presentation 1

Title: How good is staged SRS for large AVMs?

Macquarie Neurosurgery

Evidence Based Surgery presentation

Date: June 21, 2012

NJP

EBS presentation 2

Clinical case

• Recently we saw the results for surgical treatment of SPM grade 4,5.

• Surgery Results are: 5% death, 20% morbidity, 100% cure.

• SRS for these lesions is: 36% obliteration, 36% bleed for > 10cm3

• Can stage SRS do better?

EBS presentation 3

Clinical Example

EBS presentation 4

Searchable question (PICO format)

• What is the obliteration rate, bleed rate, side effect rate for large AVMs treated by STAGED SRS?

EBS presentation 5

Search strategy

• P: Patients with Large AVM• I: Staged SRS• C: surgery avm (Not searched here)• O: obliteration, death, side effect, bleed

EBS presentation 6

Medline: 35 found, 24 kept.

EBS presentation 7

Embase – Using EMTree.Found 20 kept 16

EBS presentation 8

Scopus: 55 found.

EBS presentation 9

Summary of papers

• Table

EBS presentation 10

Summary

• 35-66 % Obliteration. Mean 42%• Not as many deaths as I expect, before

obliteration, after treatment.

EBS presentation 11

Conclusions

• Low side effects, low efficacy.

• IN those non-surgical patients, should we given them SRS for a 33% chance of cure?

• If they fail, perhaps its becomes surgical?

EBS presentation 13

Proposal to study EBS?

• Compare our EBS strategy results to published neurosurgery article results.