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 journalArticlepeer-review

    3 Citations (Scopus)


    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.

    Original languageEnglish
    Pages (from-to)655-661
    Number of pages7
    Issue number3
    Publication statusPublished - 1 Mar 2019


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


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