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24 April 2014

Surgery not the answer for brain abnormality

No treatment and the use of medications to control seizures is the better approach for patients with unruptured brain arteriovenous malformations.

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People with abnormal connections between arteries and veins in the brain may be less likely to suffer a stroke or die if they don't undergo any procedures to correct the problem, new research suggests.

The study included 204 patients in Scotland who had these types of abnormal connections – called "brain arteriovenous malformations" or bAVMs – that had not ruptured.

Read: The mystifying brain

Conservative management

Of those patients, 103 decided to undergo one of three types of treatment: open brain surgery, minimally invasive surgery using a catheter, or targeted radiation therapy.

The other patients chose "conservative management", which means no treatment and the use of medications to control seizures.

Those who chose surgery or radiation tended to be younger, more likely to have suffered seizures and less likely to have large bAVMs, the study authors noted.

Read:  Mild brain injuries kill brain tissue

Over an average follow-up period of nearly seven years, rates of disability or death were lower in the non-treatment group than in the treatment group during the first four years, but were similar after that, according to the study. It was published in the Journal of the American Medical Association.

Over 12 years, 14 patients in the non-treatment group suffered a non-fatal stroke or died, compared with 38 patients in the treatment group, the investigators found.

Long-term follow-up needed

The findings suggest that conservative management is the better approach for patients with unruptured bAVMs.

But long-term follow-up is needed to determine whether this continues to be the case over many years, Rustam Al-Shahi Salman, of the University of Edinburgh in Scotland, and colleagues explained in a journal news release.

Although the study found an association between lower rates of nonfatal stroke or death in the study participants who avoided surgery or radiation treatment, it did not prove a cause-and-effect relationship.


Read more:

What is arteriovenous malformation?
What do you call it when the cerebellum portion of the brain goes down into the spinal canal?


 
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