Management of brain arteriovenous malformations

摘要

It is difficult to conduct a randomised controlled trial to compare policies of conservative management versus interventional treatment for brain "timebombs" that could bleed. Incomplete understanding of natural history often leads to extrapolations of short-term event rates to patients' lifetimes and so an unfavourable indirect comparison with clinicians' estimates of the risks of intervention. These issues result in the recruitment of a small number of eligible patients in clinical practice.12 Furthermore, some patients and clinicians (probably more so those who treat the conditions in fee-for-service health-care systems) might prefer preventative interventions. Consequently, despite the fact that ARUBA delivered a result deemed definitive by its Data Monitoring Committee,2 the external validity-or generalisability-of ARUBA's participants and interventions has been criticised both before and after ARUBA's results were known.