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  • A Systematic Literature Review for the Global Incidence of Central Nervous System Vascular Lesions and Meta-Analysis of Hemorrhagic Aneurysms, Arteriovenous Malformations, and Dural Arteriovenous Fist

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    Joshua David Hughes MD; Kamila M Bond; Rania A Mekary PhD; Michael C. Dewan MD; Abbas Rattani; Yoko Kato MD; Hildo R. Cirne Azevedo-Filho MD, MSc, PhD, FRCS Ed; Jacques J. Morcos MD, FRCS(Eng), FRCS(Ed); Kee B. Park

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    Meeting: Congress of Neurological Surgeons 2017 Annual Meeting

    Introduction: Surgery is increasingly important in global health initiatives. Neurosurgical care is as limited as 1-to-10 million people in parts of the world. We examined the worldwide incidence of hemorrhagic aneurysms(ASAH), AVM(HAVM), and dural arteriovenous fistulas(HDAVF) to define disease burden and inform neurosurgical global health efforts.

    Methods: A systematic literature review was done according to the PRISMA guidelines for epidemiologic data for ASAH, HAVM, and HDAVF. Our primary objective was to estimate the global epidemiology of these lesions. Manuscripts were graded on a 6-point scale and included both hospital and population-based studies with data for incidence calculation. Results were organized by WHO regions [USA/Canada(AMR-US/Can);Latin America(AMR-L);South-East Asia(SEAR); European(EUR);Eastern Mediterranean(EMR);and Western Pacific(WPR)] and country income level(high and middle/low). After literature review, there was a lack of data from AMR-L, SEAR, EMR, and AFR. Using the remaining studies and a series of assumptions from 12 high-quality stroke studies, we estimated the crude incidence of ASAH, HAVM, and HDAVF. Estimates were generated using random effects model, and displayed in disease-specific Forest plots; study quality was examined by region and income group with univariate meta-regression.

    Results: From an initial yield of 1,492 studies, 58 studies were found and combined with the 12 stroke studies. By WHO region, EMR had the lowest ASAH rates(0.69/100,000), while WPR had the highest(12.38/100,000). HAVM rates were lowest in EMR(0.01/100,000)and highest in Europe(0.43/100,000). HDAVF were lowest in AMR-US/CAN(0.05/100,000) and highest in Europe(0.1/100,000). We estimate the global crude incidence for ASAH, HAVM, and HDAVF are 6.69, 0.23, and 0.01 per 100,000 persons respectively and calculate that 491,625(95%CI 332,159–680,390); 16,833(95%CI 7,319–30,007); and 1,964(95%CI 527–13,837)people suffer these lesions each year.

    Conclusions: To our knowledge, this is the first systematic literature review on the global incidence of ASAH, HAVM, and DAVF. Worldwide, we estimate just over 500,000 individuals will suffer yearly from lesions.

    Patient Care: This research will help define disease burden and inform neurosurgical global health efforts.

    Learning Objectives: By the conclusions of this session, participants should be able to know the estimated global and regional incidence of hemorrhagic aneurysms, arteriovenous malformations, and dural arteriovenous fistulas


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