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Comment & Response
September 10, 2014

Conservative Management vs Intervention for Unruptured Brain Arteriovenous Malformations

Author Affiliations
  • 1Department of Neurological Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
JAMA. 2014;312(10):1057-1058. doi:10.1001/jama.2014.8748

To the Editor Management of brain arteriovenous malformations (bAVMs) has been debated in the recent medical literature. If left untreated, bAVMs confer a risk of neurological morbidity and mortality; however, treatment is associated with risks but offers the potential for lifetime eradication.

Dr Al-Shahi Salman and colleagues1 prospectively followed up 204 patients with unruptured bAVMs over 12 years. Morbidity and mortality rates among patients managed conservatively vs those who underwent interventions (surgical resection, endovascular treatment, radiosurgery, or multimodal intervention) were compared. Over a 4-year period, the authors reported 36 events leading to sustained disability or death in the conservative management group vs 39 in the intervention group. The number of bAVM-associated symptomatic strokes or deaths in patients managed conservatively vs with an intervention was 14 vs 38, respectively.

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