{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,16]],"date-time":"2026-04-16T16:16:38Z","timestamp":1776356198163,"version":"3.51.2"},"reference-count":88,"publisher":"Journal of Neurosurgery Publishing Group (JNSPG)","issue":"6","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2025,12,1]]},"abstract":"<jats:sec>\n                    <jats:title>OBJECTIVE<\/jats:title>\n                    <jats:p>Cavernous malformations are low-flow vascular anomalies within the central nervous system, notable for their potential to cause seizures or intraparenchymal hemorrhage. Currently, no consensus exists to recommend a specific interval for following radiographic imaging of cerebral cavernous malformations (CCMs) that are not treated with either resection or radiation. Herein, the authors aimed to determine the most cost-effective strategy for MRI follow-up of CCM in both brainstem and nonbrainstem locations in order to enable earlier diagnosis and potentially circumvent fatal events due to CCM-related hemorrhages.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>METHODS<\/jats:title>\n                    <jats:p>A decision analysis was performed using a Markov model with Monte Carlo simulations for patients with CCMs undergoing MRI follow-up at different time intervals (0.5-, 1-, 2-, and 3-year intervals). Input data for the model were extracted from the current literature, primarily meta-analyses, and the willingness-to-pay threshold was defined as $50,000 per quality-adjusted life year (QALY), as standard in the United States. Probabilistic and deterministic sensitivity analyses were performed to evaluate the robustness of the model.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>RESULTS<\/jats:title>\n                    <jats:p>Given the current literature and the authors\u2019 model, MRI follow-up every 1 year for brainstem CCM is the most cost-effective strategy (cost $395,580, effectiveness 20.42 QALYs), showing the highest net monetary benefit. For nonbrainstem CCM, follow-up every 3 years with MRI was the most cost-effective strategy (cost $125,438, effectiveness 23.23 QALYs). This conclusion remains robust in probabilistic and deterministic sensitivity analyses.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>CONCLUSIONS<\/jats:title>\n                    <jats:p>For patients followed conservatively, the most cost-effective follow-up strategy for brainstem CCM using MRI is every 1 year, while for nonbrainstem CCM, follow-up every 3 years tends to be the most cost-effective. More frequent follow-up strategies for nonbrainstem CCM or prompt preventive treatment would be more appropriate in symptomatic patients or patients with higher risk factors for hemorrhagic events.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3171\/2025.4.jns243100","type":"journal-article","created":{"date-parts":[[2025,8,2]],"date-time":"2025-08-02T01:27:06Z","timestamp":1754098026000},"page":"1555-1566","source":"Crossref","is-referenced-by-count":2,"title":["Optimal imaging follow-up strategies for conservatively managed cerebral cavernous malformations: a cost-effectiveness analysis"],"prefix":"10.3171","volume":"143","author":[{"given":"Aryan","family":"Wadhwa","sequence":"first","affiliation":[{"name":"Neurosurgical Service, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Mira","family":"Salih","sequence":"additional","affiliation":[{"name":"Neurosurgical Service, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Felipe","family":"Ramirez-Velandia","sequence":"additional","affiliation":[{"name":"Neurosurgical Service, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Samuel D.","family":"Pettersson","sequence":"additional","affiliation":[{"name":"Neurosurgical Service, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Sandeep","family":"Muram","sequence":"additional","affiliation":[{"name":"Neurosurgical Service, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Michael","family":"Young","sequence":"additional","affiliation":[{"name":"Neurosurgical Service, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Philipp","family":"Taussky","sequence":"additional","affiliation":[{"name":"Neurosurgical Service, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Christopher S.","family":"Ogilvy","sequence":"additional","affiliation":[{"name":"Neurosurgical Service, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1754","reference":[{"issue":"5","key":"b1","series-title":"Neurosurgery","first-page":"665","article-title":"Synopsis of guidelines for the clinical management of cerebral cavernous malformations: consensus recommendations based on systematic literature review by the Angioma Alliance Scientific Advisory Board Clinical Experts Panel","volume":"80","author":"Akers A","year":"2017","unstructured":"Akers A, Al-Shahi Salman R, A Awad I,  Synopsis of guidelines for the clinical management of cerebral cavernous malformations: consensus recommendations based on systematic literature review by the Angioma Alliance Scientific Advisory Board Clinical Experts Panel. 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