EMBOLIZATION BEFORE RADIOSURGERY REDUCES THE OBLITERATION RATE OF ARTERIOVENOUS MALFORMATIONS
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Bibliographic record
Abstract
OBJECTIVE: To evaluate the arteriovenous malformation (AVM) obliteration rate and the clinical outcome after radiosurgery in patients with and without previous embolization. METHODS: Of 244 patients who underwent linear accelerator radiosurgery for AVMs at the Sunnybrook Health Sciences Centre between 1989 and 2000, 61 patients had embolization before radiosurgery and complete follow-up for at least 3 years. For 47 of these 61 patients (Group A, embolization plus radiosurgery), we were able to find 47 matching patients without previous embolization (Group B, radiosurgery alone). This group of matching patients had the same AVM volume (after embolization in Group A), location, and marginal dose. The radiosurgery-based AVM score and the obliteration prediction index were calculated. RESULTS: The median follow-up period was 44 months. Nidus obliteration was achieved in 22 patients in Group A (47%) and 33 patients in Group B (70%, P = 0.036). Permanent deficit related to hemorrhage or radiation occurred in three patients (6%) in Group A and three patients (6%) in Group B. During the first 3 years after radiosurgery, two patients (4%) in Group A experienced hemorrhage; in Group B, five patients (11%) experienced hemorrhage (P = 0.2). In Group B, two patients (4%) died and two patients (4%) had their AVM surgically removed. Both deaths were related to hemorrhage during the latency period. The excellent outcome (obliteration plus no deficit) in Group A was 47% compared with 64% in Group B (P = 0.146). There was no difference in the obliteration prediction index and the radiosurgery-based AVM score between Groups A and B. The predicted rates of obliteration and excellent outcome were 55 and 62.5%, respectively, according to the obliteration prediction index and the radiosurgery-based AVM score. CONCLUSION: Embolization before radiosurgery significantly decreases the obliteration rate, even in AVMs with the same volume, location, and marginal dose. Although an excellent outcome rate was higher in the group without embolization, this was not statistically significant.
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Full frame distilled prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. Learned from the 10,348 direct Codex labels and 10,348 direct Gemma labels. Candidate is the union of thresholded teacher heads; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels or direct frontier model labels.
Codex and Gemma teacher scores by category
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.000 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.000 | 0.000 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.000 | 0.000 |
Machine scores (provisional)
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Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from it