DECISION MAKING IN AVM TREATMENT STRATEGY ::TREATMENT BOARD SYSTEM AT TOHOKU UNIVERSITY

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Treatment of some large, deep-seated arteriovenous malformations is still a challenge to neurosurgeons. Recent development of non-invasive imaging modalities has increased the chance of finding asymptomatic AVM's, for which evaluation of risk and benefit of treatment is more complicated than in symptomatic cases. Currently there are three major treatment options for AVM : microsurgical removal, radiosurgery, and intravascular embolization. It is not easy task for us neurosurgeons to choose the best single modality or combination of modalities for individual patients, who have different types of onset, neurological deficits, size and location, and social background. After the installation of the Gamma Knife in November 1991, we established an "AVM Treatment Board". It consists of vascular neurosurgeons, endovascular neurosurgeons, and radio-neurosurgeons, and meetings are twice a month. Every AVM case referred to us is presented to the board, and treatment strategy is selected after a discussion among experts who know the advantages and drawbacks of each treatment modality. This paper describes this board system in detail and emphasizes the importance of gathering expertise in decision making.
北関東医学会の論文