{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,13]],"date-time":"2026-08-13T06:57:30Z","timestamp":1786604250659,"version":"build-2736575974"},"reference-count":19,"publisher":"SAGE Publications","issue":"9","license":[{"start":{"date-parts":[[2019,5,23]],"date-time":"2019-05-23T00:00:00Z","timestamp":1558569600000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["International Journal of Stroke"],"published-print":{"date-parts":[[2019,12]]},"abstract":"<jats:sec>\n                    <jats:title>Introduction<\/jats:title>\n                    <jats:p>We aimed to evaluate the preferred treatment strategy for patients with symptomatic cerebral cavernous malformations (CCM).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>In a decision model, we compared neurosurgical, radiosurgical, and conservative management. A literature review yielded the risks and outcomes of interventions, intracerebral hemorrhage (ICH), and seizures. Patients with CCM rated their quality of life to determine utilities. We estimated the expected number of quality-adjusted life years (QALYs) and the ICH recurrence risk over five years, according to mode of presentation and CCM location (brainstem vs. other). We performed analyses with a time horizon of five years.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Using the best available data, the expected number of QALYs for brainstem CCM presenting with ICH or focal neurological deficit was 2.84 (95% confidence interval [CI]: 2.54\u20133.08) for conservative, 3.01 (95% CI: 2.86\u20133.16) for neurosurgical, and 3.03 (95% CI: 2.88\u20133.18) for radiosurgical intervention; those for non-brainstem CCM presenting with ICH or focal neurological deficit were 3.08 (95% CI: 2.85\u20133.31) for conservative, 3.21 (95% CI: 3.01\u20133.36) for neurosurgical, and 3.19 (95% CI: 2.98\u20133.37) for radiosurgical intervention. For CCM presenting with epilepsy, QALYs were 3.09 (95% CI: 3.03\u20133.16) for conservative, 3.33 (95% CI: 3.31\u20133.34) for neurosurgical, and 3.27 (95% CI: 3.24\u20133.30) for radiosurgical intervention.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Discussion and conclusion<\/jats:title>\n                    <jats:p>For the initial five years after presentation, our study provides Class III evidence that for CCM presenting with ICH or focal neurological deficit conservative management is the first option, and for CCM presenting with epilepsy CCM intervention should be considered. More comparative studies with long-term follow-up are needed.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1177\/1747493019851290","type":"journal-article","created":{"date-parts":[[2019,5,23]],"date-time":"2019-05-23T21:26:28Z","timestamp":1558646788000},"page":"939-945","update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":23,"title":["Radiosurgical, neurosurgical, or no intervention for cerebral cavernous malformations: A decision analysis"],"prefix":"10.1177","volume":"14","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-0291-8515","authenticated-orcid":false,"given":"Leon A","family":"Rinkel","sequence":"first","affiliation":[{"name":"University Medical Centre Groningen, University of Groningen, Groningen, the Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rustam Al-Shahi","family":"Salman","sequence":"additional","affiliation":[{"name":"Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gabriel JE","family":"Rinkel","sequence":"additional","affiliation":[{"name":"Department of Neurology and Neurosurgery, University Medical Center Utrecht, Utrecht, the Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jacoba P","family":"Greving","sequence":"additional","affiliation":[{"name":"Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, the Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"179","published-online":{"date-parts":[[2019,5,23]]},"reference":[{"key":"bibr1-1747493019851290","doi-asserted-by":"publisher","DOI":"10.1161\/STROKEAHA.108.515544"},{"key":"bibr2-1747493019851290","doi-asserted-by":"publisher","DOI":"10.1016\/S1474-4422(15)00303-8"},{"key":"bibr3-1747493019851290","doi-asserted-by":"publisher","DOI":"10.1055\/s-0035-1552621"},{"key":"bibr4-1747493019851290","doi-asserted-by":"publisher","DOI":"10.1212\/WNL.0000000000000684"},{"key":"bibr5-1747493019851290","doi-asserted-by":"publisher","DOI":"10.1093\/neuros\/nyx091"},{"key":"bibr6-1747493019851290","doi-asserted-by":"publisher","DOI":"10.1007\/s00701-013-1621-4"},{"key":"bibr7-1747493019851290","doi-asserted-by":"publisher","DOI":"10.1177\/0272989X9301300409"},{"key":"bibr8-1747493019851290","doi-asserted-by":"publisher","DOI":"10.1136\/jnnp.2006.113753"},{"key":"bibr9-1747493019851290","doi-asserted-by":"publisher","DOI":"10.1212\/WNL.0b013e3182190f37"},{"key":"bibr10-1747493019851290","unstructured":"National Records of Scotland.\n                      Deaths rate, by sex and age, Scotland 2001\u20132015\n                      , www.nrscotland.gov.uk (2015, accessed 16 December 2016)."},{"key":"bibr11-1747493019851290","doi-asserted-by":"publisher","DOI":"10.4103\/2152-7806.157071"},{"key":"bibr12-1747493019851290","doi-asserted-by":"publisher","DOI":"10.1016\/j.wneu.2016.08.014"},{"key":"bibr13-1747493019851290","doi-asserted-by":"publisher","DOI":"10.1227\/NEU.0b013e31821d31b7"},{"key":"bibr14-1747493019851290","doi-asserted-by":"publisher","DOI":"10.1016\/0168-8510(90)90421-9"},{"key":"bibr15-1747493019851290","doi-asserted-by":"crossref","unstructured":"Devlin NJ, Shah KK, Feng Y, Mulhern B and van Hout B. 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