Treatment of symptomatic cerebral cavernous malformations: a decision

Rinkel, L. (Leon) (2017) Treatment of symptomatic cerebral cavernous malformations: a decision. thesis, Medicine.

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Abstract

There is a lack of evidence from randomised controlled trials or observational studies that show dramatic effect to inform the decision for treatment for cerebral cavernous malformations (CCM). CCM can either be managed conservatively, or can be treated with neurosurgical excision or stereotactic radiosurgery (SRS). I created decision models in order the determine the effectiveness of the different management strategies for symptomatic CCM. I used Markov models to compare the effectiveness of conservative management, neurosurgical excision and stereotactic radiosurgery, measured in quality-adjusted life years (QALYs). Different models were created based on the location on mode of presentation of CCM. I reviewed the literature to identify inputs for the models, and conducted a survey among CCM patients to determine utility values. I performed sensitivity analyses to assess model robustness, and identify factors that play a pivotal role in the decision for treatment. The results show that SRS is most effective in the treatment of CCM that present with haemorrhage or focal neurological deficit if the lesion is located the brainstem. Neurosurgical excision is the most effective management strategy for symptomatic CCM in other locations. The decision for treatment is not influenced by the patient’s age. Treatment of symptomatic CCM seems slightly more effective than conservative management, but additional comparative evidence is needed to confirm this. Additional data is needed on the outcome after haemorrhage and occurrence and prognosis of focal neurological deficit, quality of life after treatment and the long-term outcomes of conservatively managed and treated CCM to allow for a better-informed decision for treatment, until data from randomised controlled trials become available.

Item Type:	Thesis (Thesis)
Supervisor name:	Faculty supervisor: and Uyttenboogaart, Maarten
Supervisor name:	Second supervisor: and Al-Shahi Salman
Faculty:	Medical Sciences
Date Deposited:	25 Jun 2020 11:03
Last Modified:	25 Jun 2020 11:03
URI:	https://umcg.studenttheses.ub.rug.nl/id/eprint/2351

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