PhotoA fairly common condition called AVM -- arteriovenous malformation -- affects about 1 in 2,000 people. It's a tangling of the blood vessels in the brain and heightens the risk of a stroke. It's often treated with surgery.

But a new study finds that surgical interventions actually increases the patient's risk of stroke in some cases. Some patients have a better outcome if doctors treat their symptoms only and not the AVM, according to the study conducted by researchers at the University of Edinburgh.

"Many patients feel that living with AVM is like living with a time bomb in your head that could explode at any time," said Prof. Rustam Al-Shahi Salman. "Patients and their doctors face difficult choices when deciding whether or not to pursue treatment. We have found that, for most people whose AVM has not caused a bleed, the risks of treatment exceed the risks of leaving it alone over 12 years."

While the findings may have statistical significance, they do not necessarily apply to every individual with the condition. Patients should consult carefully with their physicians about the treatment that is most appropriate for them. 

No one should ever make a decision about their personal healthcare solely on the basis of news reports about medical research.

Study details

Salman and his team looked at the long-term outcome of patients with the condition, which is caused by abnormal connections between the arteries and veins in the brain.

They found that, over a 12 year period, patients who chose not to be treated for their condition were less likely to have a stroke or die from related causes. These patients were also less likely to suffer sustained disability compared with those who opted for an intervention to treat the tangles.

Of 204 patients, 103 underwent intervention. Those who underwent intervention were younger, more likely to have presented with seizure, and less likely to have large AVMs than patients managed conservatively.

During a median follow-up of 6.9 years, the rate of progression to the primary outcome was lower with conservative management during the first 4 years of follow-up, but rates were similar thereafter. 

This is the first study to compare the risks and benefits of treatment for AVM in the long term. The findings build on previous research that reported an increased risk of stroke in the first three years after treatment for AVM.

The study was published in the Journal of the American Medical Association.

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