Results of surgery for low-grade brain arteriovenous malformation resection by early career neurosurgeons: an observational study

Nirav J. Patel, David Bervini, Behzad Eftekhar, Andrew Stewart Davidson, Daniel C. Walsh, Nazih N. Assaad, Michael Kerin Morgan

Research output: Contribution to journalArticleResearchpeer-review

Abstract

Background: For sustainability of arteriovenous malformation (AVM) surgery, results from early career cerebrovascular neurosurgeons (ECCNs) must be acceptably safe. Objective: To determine whether ECCNs performance of Spetzler-Ponce Class A AVM (SPC A) resection can be acceptably safe. Methods: ECCNs completing a cerebrovascular fellowship (2004-2015) with the last author were included. Inclusion of the ECCN cases occurred if they: had a prospective database of all AVM cases since commencing independent practice; were the primary surgeon on SPC A; and had made the significant management decisions. All SPC A surgical cases from the beginning of the ECCN's independent surgical practice to a maximum of 8 yr were included. An adverse outcome was considered a complication of surgery leading to a new permanent neurological deficit with a last modified Rankin Scale score >1. A cumulative summation (Cusum) plot examined the performance of each surgery. The highest acceptable level of adverse outcomes for the Cusum was 3.3%, derived from the upper 95% confidence interval of the last author's reported series. Results: Six ECCNs contributed 110 cases for analysis. The median number of SPC A cases operated by each ECCN was 16.5 (range 4-40). Preoperative embolization was performed in 5 (4.5%). The incidence of adverse outcomes was 1.8% (95% confidence interval: <0.01%-6.8%). At no point during the accumulated series did the combined cohort become unacceptable by the Cusum plot. Conclusion: ECCNs with appropriate training appointed to large-volume cerebrovascular centers can achieve results for surgery for SPC A that are not appreciably worse than those published from high-volume neurosurgeons.

LanguageEnglish
Pages655-661
Number of pages7
JournalNeurosurgery
Volume84
Issue number3
DOIs
Publication statusPublished - 1 Mar 2019

Fingerprint

Arteriovenous Malformations
Observational Studies
Brain
Confidence Intervals
Neurosurgeons
Databases
Incidence

Keywords

  • Arteriovenous malformation
  • AVM
  • Brain
  • Cumulative summation
  • Cusum
  • Outcome
  • Surgery

Cite this

Patel, Nirav J. ; Bervini, David ; Eftekhar, Behzad ; Davidson, Andrew Stewart ; Walsh, Daniel C. ; Assaad, Nazih N. ; Morgan, Michael Kerin. / Results of surgery for low-grade brain arteriovenous malformation resection by early career neurosurgeons : an observational study. In: Neurosurgery. 2019 ; Vol. 84, No. 3. pp. 655-661.
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abstract = "Background: For sustainability of arteriovenous malformation (AVM) surgery, results from early career cerebrovascular neurosurgeons (ECCNs) must be acceptably safe. Objective: To determine whether ECCNs performance of Spetzler-Ponce Class A AVM (SPC A) resection can be acceptably safe. Methods: ECCNs completing a cerebrovascular fellowship (2004-2015) with the last author were included. Inclusion of the ECCN cases occurred if they: had a prospective database of all AVM cases since commencing independent practice; were the primary surgeon on SPC A; and had made the significant management decisions. All SPC A surgical cases from the beginning of the ECCN's independent surgical practice to a maximum of 8 yr were included. An adverse outcome was considered a complication of surgery leading to a new permanent neurological deficit with a last modified Rankin Scale score >1. A cumulative summation (Cusum) plot examined the performance of each surgery. The highest acceptable level of adverse outcomes for the Cusum was 3.3{\%}, derived from the upper 95{\%} confidence interval of the last author's reported series. Results: Six ECCNs contributed 110 cases for analysis. The median number of SPC A cases operated by each ECCN was 16.5 (range 4-40). Preoperative embolization was performed in 5 (4.5{\%}). The incidence of adverse outcomes was 1.8{\%} (95{\%} confidence interval: <0.01{\%}-6.8{\%}). At no point during the accumulated series did the combined cohort become unacceptable by the Cusum plot. Conclusion: ECCNs with appropriate training appointed to large-volume cerebrovascular centers can achieve results for surgery for SPC A that are not appreciably worse than those published from high-volume neurosurgeons.",
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Results of surgery for low-grade brain arteriovenous malformation resection by early career neurosurgeons : an observational study. / Patel, Nirav J.; Bervini, David; Eftekhar, Behzad; Davidson, Andrew Stewart; Walsh, Daniel C.; Assaad, Nazih N.; Morgan, Michael Kerin.

In: Neurosurgery, Vol. 84, No. 3, 01.03.2019, p. 655-661.

Research output: Contribution to journalArticleResearchpeer-review

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