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  • Results of Surgery for Low-grade Brain Arteriovenous Malformation Resection by Early Career Neurosurgeons: An Observational Study

    Final Number:

    Nirav J. Patel MD MA; David Bervini MD; Behzad Eftekhar MD, FRACS; Andrew S Davidson MA, MS, PhD; Daniel C Walsh; Nazih Assaad; Michael Kerin Morgan MD, MBBS, FRACS

    Study Design:

    Subject Category:

    Meeting: Congress of Neurological Surgeons 2018 Annual Meeting

    Introduction: Background: For sustainability of AVM surgery, results from early career cerebrovascular neurosurgeons (ECCNs) must be acceptably safe. Objective: To determine whether, ECCNs performance of 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 ECCN's independent surgical practice to a maximum of eight years. 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% CI of the last author's reported series.

    Results: 6 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%CI: <0.01- 6.8%). At no point during the accumulated series did the combined cohort become unacceptable by the Cusum plot.

    Conclusions: 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. Surgical techniques can codified, be learned and applied for good results early in a one's career, justify continuing surgical care.

    Patient Care: Keeping track of surgical results is paramount to delivering the best possible care. This study helps benchmark results of early career neurosurgeons. This information is necessary when making a management decisision for brain AVMs.

    Learning Objectives: Results of brain avm surgery for grades 1 and 2. Fellowship training is helpful in achieving good results. Techniques of brain avm resection will be reviewed.


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