抄録
Treatment for a small cerebral arteriovenous malformation (AVM) less than 3 cm in diameter is selected from the 3 options: gamma knife surgery (GKS), microsurgery or conservative treatment. To choose the optimal therapeutic modality, the authors examined a total of 613 patients with small AVM using clinical decision analysis. Expected utility after treatment was estimated from each therapeutic results, a patient's age and history of previous bleeding. The utility was assumed as 100 for without disability, 75 for with disability and 0 for dead. The expected utility after microsurgery was the highest in patients younger than 50 years without previous bleeding, or younger than 60 years with previous bleeding. GKS was optimal for a patient aged between 50 and 70 years with previous bleeding, or aged older than 60 years with previous bleeding. The clinical decision analysis provides us useful information for selecting a preferable treatment in the patients with a small AVM.
