Title: How good is staged SRS forlarge AVMs?          Macquarie Neurosurgery   Evidence Based Surgery presentation   Date:...
Clinical case• Recently we saw the results for surgical  treatment of SPM grade 4,5.• Surgery Results are: 5% death, 20%  ...
Clinical Example                   EBS presentation   3
Searchable question (PICO format)• What is the obliteration rate, bleed rate, side  effect rate for large AVMs treated by ...
Search strategy•   P: Patients with Large AVM•   I: Staged SRS•   C: surgery avm (Not searched here)•   O: obliteration, d...
Medline: 35 found, 24 kept.                              EBS presentation   6
Embase – Using EMTree.Found 20 kept 16                         EBS presentation   7
Scopus: 55 found.                    EBS presentation   8
Summary of papers• Table                    EBS presentation   9
Summary• 35-66 % Obliteration. Mean 42%• Not as many deaths as I expect, before  obliteration, after treatment.           ...
Conclusions• Low side effects, low efficacy.• IN those non-surgical patients, should we  given them SRS for a 33% chance o...
Kano•   90% of cases are grade 4 or 5•   17/47 = 36% obliterated after 10 years•   8/47 = 17% died of bleeding•   ARE     ...
Proposal to study EBS?• Compare our EBS strategy results to  published neurosurgery article results.                      ...
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Ebs staged srs for large am vs_june - copy

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  • Ebs staged srs for large am vs_june - copy

    1. 1. Title: How good is staged SRS forlarge AVMs? Macquarie Neurosurgery Evidence Based Surgery presentation Date: June 21, 2012 NJP EBS presentation 1
    2. 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 2
    3. 3. Clinical Example EBS presentation 3
    4. 4. Searchable question (PICO format)• What is the obliteration rate, bleed rate, side effect rate for large AVMs treated by STAGED SRS? EBS presentation 4
    5. 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 5
    6. 6. Medline: 35 found, 24 kept. EBS presentation 6
    7. 7. Embase – Using EMTree.Found 20 kept 16 EBS presentation 7
    8. 8. Scopus: 55 found. EBS presentation 8
    9. 9. Summary of papers• Table EBS presentation 9
    10. 10. Summary• 35-66 % Obliteration. Mean 42%• Not as many deaths as I expect, before obliteration, after treatment. EBS presentation 10
    11. 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 11
    12. 12. Kano• 90% of cases are grade 4 or 5• 17/47 = 36% obliterated after 10 years• 8/47 = 17% died of bleeding• ARE EBS presentation 12
    13. 13. Proposal to study EBS?• Compare our EBS strategy results to published neurosurgery article results. EBS presentation 13

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